HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MLIST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 214y
- Permit Number:
LTCM
Building Permit Application
Planning and Deve/opment5ervices
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial Residential
CBDG Funding
PERMIT APPLICATION FOR:
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PROPOSED IMPROVEMENT LOCA ION:
Address:
Property Tax ID #: L f
Lot No.
Site Plan Name: U �
Block No.
Project Name:
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:
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: $ _ Z8 ° ") Utilities: Sewer Se tic B 'Id'
vwlvtK/LE$5EE:
Name rc
Addre `�
aL
City: Q � I State:
Zip Code: L 2 Fax:
Phone No.
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
_ p ung Height:
CONTRACTOR: -
Name: V
Company:
r Address: ry
City: -j�/ � C State:
E- Zip Code: '
Fax:
Phone No ;.
E-Mail et
State or Cou ty 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.
---'"I + "P%%-1 vn Mrrivvs i ;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 County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
I with lender Oran attorney before commencing work or recording your Notice of Commencement.
Sign ture of Contractors( -- or - Owner Builder as applicable
STATE OF FLORIDA \¢�-` �{1.. I()
COUNTY OF `�-J
Swo (or affirmed) and su
this day of --�
Name of persdri'making
Commission No.
d before me of Physical Presence or Online Notarization
20_ff by
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OR Produced Identification
uced
REVIEWS I FRONT
COUNTER
DATE
RECEIVED
DATE
COMPLETED
of Florida)
iqy p<B KATHERINE HAVENS
W,wn w
(Seal)? MY COMMISSION #HH1 99309
EXPIRES: DEC 04, 2025
Bonded through 1 st State Insurance
ROEVI W I NING SUPERVISREVIIEWOR I REV EW VREVIEWON I SEATURTREVIEW EWLE I MREVEWVE