HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
LL c LL
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:
Property Tax ID #: ��� ~ �° O
Site Plan Name: ,"C' �� �►
Project Name:
New Electrical Meter Second Electrical Meter__
CONSTRUCTION INFORMATION:
(Affidavit required)
Lot No. S
Block No.
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: $ '0 C3 S Utilities: _Sewer _Septic
Building Height:
OWNERAESSEE:
CONTRACTOR:
Name wnA Lj%w$ C
Name:
Address: sb Q �
Company: V
City: J t`n�Q-r1 �Q,�t �- State:
Zip Code: Fax:
Phone No.-�\3 "�3� 1V S� E-
Address: S (W zN C`
City:�t 5ye-1 C State:
Zip Code WS 3 F 51I.-cl
Phone No 112" (l I " �� U4
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail V \� 41x ��0 Q-5 �h�- ���� •�dm
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is requirea.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER- Not Applicable
Name: J 4At% t C 1NIA
Address: oc W Ch lw►
City• T State:
Zip:33 Phone-- ^
FEE SIMPLE TITLE HOLDER
Name:
Address:
Citv:
Zip: Phone: _
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name: _
Address:
City: _
Zip:
Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as inaicaieo.
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
iL 1--.J-- - -4-4 .rr.r.., knf„ro rn nnrinU %Alnrlt nr rimmrdino vnt,r Notice of Commencement.
WILII CIIUCI UI all a«vi tic
--
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA o
Q.
COUNTY OF St L%3 C,
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this �S dayof 2012- by
�jp►vq�nl NoSk�NS
-
Name of person making statement.
Personally Known V OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- Stateo Florida)
ofFlorida
2A �Commission l
MEE
No. (Seal)
290092
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 10/12/21