HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
L-! L�
P ti c Imo; c D Cn" - w Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34992
Phone: (772)462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: I 1
Property Tax ID#: .'-l (,;��' ( - �� Lot No.
Site Plan Name: r Block No.
Project Name:_���
[DqA1L17 DESCRIPTION OF WORK:
IC
New Electrical Meter Second Electrical Meter (Affidavit required)
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: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Y Name: f U
Address: - Company: 4
City: �JJ_Lc h State:�I Address: -Zip Coder r Fax: City: S ate: FL
Phone No.gLiL- (Q R - , �ES7 E- Zip Code: C Fax:
Mail: Phone No_��
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License - ' —
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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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLD!t� N A plicable BONDING COMPANY. No Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 conflicts with any applicable Homeowners Association rules,bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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 I 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 Cou ty and,.-Posted n the jobsite before the first inspection. If you intend to obtain financing, consult
with lend r or an attorn bef re commencing work or recording our Notice of Commencement.
Signature of Co' ractor-o l-Owner Builder as applicable
STATE OF FLORID
COUNTY OF
Sworn to(or affir ed)and subscribed before me of Physical Presence or Online Notarization
this day of-Leb(V CW\1 12G by
Name of person m king statement.
"KnownR Produced Identification
du ed/ bli at
of Florida)
4�— � 1► fay,
A"" JOAN THAYER
mission No. (Seal) ' "'• ° Commission#GG 282897
N a� Expires December 9,2022 i
9rF 0i"- 80Wed Tleu eudgQt Wwy Serr W
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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