HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: '�?, la 2!0 Permit Number: `�a�3 • �3��
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: ZW6— �Oc�%OOTi
Property Tax ID #: �c�a��/)�%� d/9 ���a Lot No.
Site Plan Name: Block No.
Project Name: /2a-9
DETAILED DESCRIPTION:'OF WORK:.
New Electrical Meter k""' 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: $ > Utilities: _Sewer _Septic
Building Height:
°OWNER/LESSEE;
CONTRACTOR:
Name %?% /z /Z"
Name:
Address: 7705- Ge/pOp
Company: 4155
City: O ��.� � State d
Address: t/cc5X/
Zip Code: Fax:
City: C �! State:/��
Phone No. �y�/6% ,��� 3�� E-
/i
Zip Code:3,7?6Z Fax: Wiz) yy07y
Mail:
r
Phone No Z
Fill in fee simple Title Holder on next page (if different
E-Mail
from the Owner listed above)
State or County License_ 6�� 619MO-10
It 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.
V
SUP TEMENTA , NSTR�UCTION LI N L�A1N INFORMATION
p .
DESIGNER/ENGINEER: _
of 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:
_ of 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.
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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 consu t with your Homeowners Association and review your deed for any restrictions which may apply.
In consideration of tie 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, cons
with lender nr an afire commencing work or rprnrding vnur Nntira of rnmmanramant
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OFF., O r 2: v-
Sworn to (or affirmed) and subscribed before me of it
Physical Presence or Online Notarization
this l day of lY7/9-c 1�1 20�by
0'q ": 0 L.: s S
Name of person making statement.
Personally Known OR Produced Identification �C
; BEN C SALTZ
Notary
a ;�; r
Type of Identification Produced tier0A Lcc..Oj
Public • State of Florida
1 Commission : HH 146049
E
C
My Comm. Expires Jul 9, 2025
ded through National Notary Assn.
(Signature of Notary Public- State of Florida)
Commission No. �� oV 4(Seal)
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