HomeMy WebLinkAboutBuilding Permit app,I APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
t.z 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 CBDG Funding
PERMIT APPLICATION FOR: /
PROPOSED IMPROVEMENT LOCATION:
Address: �)�DU ll \(_
Property Tax ID #: �U c! �(���` � �` t La), (j Lot No.
Site Plan Name: Block No.
�}
Project Name:
DETAILED DESCRIPTION OF WORK:
r�C.3
`n
�/ n
,�
t r ,, (
ind
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:
are
Cost of Construction: $ . Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name CA
Name: l nC1 0
Address: Xo :�S jyr°_tr I_��1� �
Company:
City: StateT-_
Address: l;
Zip Code: G Fax:
City: f� State.
Phone No.��E-
Zip Cade:. Fax:
Mail:
Phone No
E-Mail La ,
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
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.
_cft
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attornary before commencine work or recordin¢ vour Notice of Commencement.
Signature of fonfractor or - Owner Builder as applicable
STATE OF FLO
COUNTY OF )
, .
Swo5,,t,�oo (or affirme ) and subscribed before me of Physical Presence or _ Online Notarization
this day of 2C'by
0
Name of person making statement.
Personally Known OR Produced Identification
e of Identification Produce,
i
(Signature of Notary Public- State of Florl,-
pANI[LLC CONCALVCS
cv�vPua
Commission No.��el„ �' ._ MV COMMISCICNtyG?32946
June97 ?QA2
EYPIRE
sondad Thu Notary Pubh lind..rwdtors _lf
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 10/12/21