HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVED
Q
Building Permit Application
Cou
Planning and Development Services St.pu�ois Ingnty
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: ��� jS Co��i✓� 2� ���.��
PROPOSED IMPROVEMENT LOCATION:
Address:Ygo S57' 1/157d
Property Tax ID#: / — J �l� c�C� Lot No. i
Site Plan Name: Block No.
Project Name: � do(Q kJ I46 � ���/J >
DETAILED DESCRIPTION OF WORK:
z s0 � G T 5 f Fug C'
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:$ em Utilities: Sewer Septic Building Height:
OWN ER/LESSEE: CONTRACTOR:
Name Name: 3
Address:_090_:!�1 &a!A- &721 33C.i_'D, Company: 41/
Cit'y��_5 Li t.Lr „r State: ,. Address: /J'S l :-5z7 f1g42-4-6��) St—
Zip Code: Fax: City + S"T J! State: L
Phone No. ;7'Z /z,9,q E- Zip Code:3�%� Fax-?9
Mail: Phone No 7Z'z?77"- W38
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License L,;7:(i* 000 7D
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 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 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 attorney,before commencing work or recording our Notice of Commencement.
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Signature of Contractor-or-Owner Builder as applicable
STATE OF FLORID
COUNTY OF�r��
Swor to(or affirmed)and s bscribed before me of Physical Presence or Online Notarization
this T day of 20 In 101
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Name of person making statement.
Personally Known OR Prodmced Identification
Type of Ide tification P odducecl
(Signature of Notary Public-State of Florida)
,,Yp�,, KAREN 7d -
ELSEN
Commission No. (Seal) a�c,PP ue��,state of Florortary Public
-` *= Commission # G a 207484
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My commission Expires
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DATE
RECEIVED
DATE
COMPLETED
Te-v-W12/21