HomeMy WebLinkAboutSLC permit applicationAll APPLPCABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
�1
�11-„
9 L c � t� ` Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 3y 1:(PV6eE! A�
Property Tax I D #: /�' ?b/� d �'S'r6 Do S Lot No. �
Block No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters —Windows/Doors _ Pond
Electric —Plumbing —Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: 5q. Ft. of First Floor:
Cost of Construction: $ It, 34a — Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name P11
Address:
City: _ �i�� Stater
Zip Code: Fax: 41—
Phone No
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company: /WG
Address: l0D B^c a3'2,;�,
City: State:J12—
Zip Code: -��}_ 495 Fax: /Y .A --
Phone No_ 92V
E-Mail��i�S�.Crii�G ate'/l�clrC •/ram �'
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
if value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as maicatea.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that 1 will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorne before commencing worm or recording our Notice of Commencement.
Signature of Owner/ Lessee/Corltr-gtor,is Agent for Owner Signature of Contractor/License/Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF— r ,_i COUNTY OF
Swofn to (or affirmea) and subscriber betore me of
Sw9y to (or affirmed) and subscribed before me of
V Physical Presence or Online Notarization
�/ Physical Presence or Online Notarization
this day of 12020 by
this day of _ .2020 by
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Name of person making statement.
Name of person makingstatement.
Personally Known v OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(signature of Notary
(Signs ure of Notary Public- State of i
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REVIEWS FRONT ZONING SUPERVISOR
PLANS VET EA TURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED