HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE I
Date: •
NFO MUST BE COMPLETED FAR APPLICATION TO BE ACCEPTED
Permit Number!:
Building Permit Application
Planning and Development Services
Building and Code fiegulation Division
2300 Virginia Avenue, Fort Pierce FL 34981
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Commercial Residential
CBDG Funding
PROPOSED IMPROVEMENT LOCATION:
Address I%���x! ik'\'rt���' 'f c\r�Ea FL ��G��
Property Tax ID ME yepo Lot No.
Site Plan Name: Block NO.
Project arse:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter (Affidavit required
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit — check all that apply:
)Lmechanical � GasTank _Gas piping _ Shutters
Electric
lPlumbing
Total Sq. Ft of Construction.
Cast of Construction: $ L�
OWNER/LESSEE:
.W,
Sprinklers
Generator
Windows/Doors
Roof
q, Ft. of First Floor: _
Utilities: � Sewer _Septic Building Height:
CONTRACTOR.
Name ►
Address:
City: i�o� ' - State:
Zip Code: .Fax:
Phone No. E-
Mail:
Fill in
fee
pimple
Title Holder on next page (if different
from
the
Owner
listed above]
If value
of
construction is
2500 or more, a RECORDED Notice of Cc
If value
of
HAVE is $7.,500
or more, a RECORDED Notice of Comm
Pond
Pitch
Name:
mpan :
Address:
Cit :
Zip Code: Fir:
Phone No 'I I P - I b�)
E- ail
State or County LicenseC(�C.�f,�ao-LA LA -4
Nnceent is required*
!nce ent 'i's required*
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
OWNER/
DESIGNER/ENGINEER: _Not Applicable
MORTGAGE COMPANY: _Not Applicable
Name.-0
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address-.
Address:
city.
City:
Zip: Phone:
Zip: Phone -
CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
certify that no work or installation has commenced prior to the issuance of a permit.
t. 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, i n 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
concurren review: room
additions,
accessory structures, swimming pools,
fences,
galls,
-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 pasted on the jobsite before the first inspection. If you intend to obtain financing, consult
with leader or an attorney before commencing work or recording your Notice of Commencement.
Signature of Owner) Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF Ha,- } , "�
Sworn to (or affirmed) and subscribed before me of
this ,� � day of �rC,UCUn 20 y
Name of person making statement.
Personally Known
Type Id�ntifica
I �
i OR Produced Identification
on Produced
(Signature of Notary Public- State of Florida)
Commission No.
EAMAPARKHURST
4 HH QM167
FwXPh3 Octoaw 20. M4
Of 10 wcw� T M moftq SWAM
!} Physical Presence or Online Notarization
REVIEWS FRONT ZQNING SUPERVISOR PLANS VEGETATION SEA TURTLE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
V I& &
I* 117ph a
MANGROVE
REVIEW