HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number.
9 Uo L UriC
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YF TWIT building Permit Application
Planning and Development Services Qe
Building and Code Regulation Division -- Commercial Residential
2360 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR
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Address: �1��`i�% C. �SL i
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Property Tax ID#: ya'a'Llr�l"a0'��-0rJ6 '`.„-..'. Lot No.
Site Plan Name: - ' Block No.
Project Name: l i'rJG� ' i✓aCA-
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New Electrical Meter, Second Electrical Meter (Affidavit required)
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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: $ y9 J Utilities: _ Sewer _ Septic Building Height:
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Name -el-gIe t :S'cG .`;i. 'i
Name:
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Address:/`l�/rc%ti+ �+�c ✓ l�✓� -,' - .:
Company
City: oe�� s�� ✓� .G Vci 8 StatStat
Address:
Zip Code: 32-llt b"i Fax:
City: State:
Phone No. 7 71� —6T,5—
Zip Code: Fax:
E-Mail: f'� 5CaC9 ?� i t��/���G
Phone No
Fill in fee simple Title Holder on next page (. if different
E-Mail —
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.
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLETITLE HOLDER: Not Applicable
BONDING COMPANY: _Not 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 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 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 r an attorney befor mencing work.or recording our Notice of Commencement.
Sig ature of Own ess or as Agent for Owner
_STATE OF FLORIDA
COUNTY OF
Swor�pto (or affirme ) and subscribed before me of _� Physical Presence or Online Notarization
this "l day of 20ZZby
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced n;
lge�
(Signature of'Notary Public- Stat Flori a) saJ1dx3 uoisslwwo0 A�
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Commission No. (Seal) eP1JON io eels-ailgnd Aje3oN ����
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 2 21