HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Nu ber:
77
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:
2 l c �
PROPOSED I'MPRQVEMENT LOCATION;
Address:
Property Tax ID#: 953 11 ) [� t �� Lot No.
Site Plan Name: Block No.
Project Name:
QETAI`LED DESCR'I!PTtON`OF WORK. ,
l
New Electrical Meter Second Electrical Meter (Affidavit required)
.CONSTRUCTIO.N,INFORMATION .;i,
Additional work to�be performed -under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters /WWiindows/Doors _Pond
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$�d %a <J C_/C� Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: CONTIACTOR= . ,
Name KY/ ( Name: 't✓." %W
an
Glom '`
Address: !) �' p1 y; J` F'� :P >: 1t� ✓�
City: State: Address_:"-,-
Zip Code: Fax: City: State:
Phone No. E- Zip Code: Fax:
Mai1:�l — i (;y�7( �/f�i/�'t7 ) f✓ Phone'rrN��o (�
Fill in fee simple Title Holder on,next page(if different E-Mailc7r-1,60&/0-2 &/ ebb' /�9f'J� cpTL
from the Owner listed above) State or County License ,_� 1,42 C Z2_
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`
SUPPLEMENTAL CONSTRUCTION LIEN.'LAW,lN'FOR'11%IATIOW
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.
Signature of Contractor-or-0 er Builder as applicable
STATE OF FLORIDA ��
COUNTY OF l, Lf�
Swor (or affirm scribed bet pre me of ✓ Physical Presence or Online Notarization
this day of ) n 2014
C5 ag- g:
Name of o making state ent.
Per nally Kn wn OR Pro d Identification
T e of Iden fica-tion du
av�
(Signat re of No ry P - t e f to id
:. JOHN M FERRICK
Co fission N (Bse13 Public-State of Florida
of �` Commission rt HH 1I7892
My Comm.Expires Aug 26,2025
Bonded through National Notary Assn.
REVIEWS_ FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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