HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ajW.()Cqq
Date: Permit Number:
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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
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #:
1- R i,
Lot No.
Site Plan Name: �� �' Block No.
Project Name: L. Gv'y sl
DETAILED DESCRIPTION OF WORK:
New Electrical Meter
Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
Mechanical _ Gas Tank _ Gas Piping
Electric lumbing _ Sprinklers
Total Sq. Ft of Construction: -
_ Shutters Windows/Doors
Generator 4— Roof
Sq. Ft. of First Floor:
Cost of Construction: $ _G.� 4&Lz_) Utilities: —Sewer �Septic
Building Height:
Pond
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name L di-f (w '1.4J.. k4-4- j L, LJ. (
Name: lL o e^
Address: her -r
Company: FCA-4t Li eP-t
City: Qc-v%y" (10-y JY 2LI ff Q State:
Address:_Z/�S'U /2,Y'4 9—
Zip Code: Fax:
City: ('�O"CCA 4 yLA-C trek State:��_
Phone No. fv1 ^ %�` - � )
Zip Code: 3� t7�� Fax:
E-Mail: J C4WVV WI++e cfilj_ . ^4 I-
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail Q /4' �! r' l / '�%C
from the Owner listed above)
State or County License C&C
If value of construction is 2500 or more, a RECORDED Notice of commencement is regwrea.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
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 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 Commencemen . ust be recorded in the public recor St.
Lucie Co my and posted on the jobsite before the first inspe . I yo tend to obtain financir g, PoAt
with lwfder or A aVorney before commencing work
or rec n our otce of Commence ent.
ignatu of Owne Less ontractor as Agent for Owner
actor/License Holder
Signat CoIRIDA
STATE OF FLORID
STA
COUNTYOF Gti�e
COU TY AZ
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Presence or Online Notarization
the-Q day of KA Ct_.> , 2029 by 70 X Q
this day of 2024 by ZZrT,1
14
Name of person making statement.
Name of person making statement.
�
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Pro uced
Produced A
► /1
1 Je/1
( nature bf Notary PI ic- St a c�'
(Signatu of Notar y%- Staang
Commission No. �'� cowl ��
Commission No. _� COMMISSION ea
2023
EXPIRES: February 5, 2023
EXPIRES: FebNalry ,
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