HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
D J I
Building Permit Application
Planning and Development Services
Building and Code Regulation Division ?'
Commercial z-%��., Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
[�aROPO5ED IMPR04'EM£NT LOCATION:
Address: Zr L) �.
Property Tax ID #: I
Site Plan Name: v
Lot No.______-_
Block No.
Project Name: _57-Z-4 �AL. r-
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
r—
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical — Gas Tank Gas Piping — p� g —Shutters
— Electric _. Plumbing Sprinklers — p i Generator
Total Sq. Ft of Construction: 3, LV r,
Cost of Construction:
OWNER/LESSEE:
(Affidavit required)
Windows/Doors _ Pond
s� Roof Pitch
Sq. Ft. of First Floor: ,
Utilities: —Sewer4 Septic Building Height:�y
CONTRACTaR:
Name :tS '- �-T-- - ---
g ! Name: Frc� Address: Z.r9��` ! r?I(( �1 � C � � � _
City:�.�r sf2�G C Company: lid ,rt L� g, a ✓ L
State: Address: �� /J Pe4l r oc
Zip Code: '; Q �'"/ Fax: j
Phone No. City: _ \y®, _69-4-
-�-t � �. yyr State:
Mail: -X
E- Zip Code: Fax: Ai70 ( - SAS • 77,YZ
Fill in fee simple Title Holder on next page (if different Phone Na
from the Owner listed above) E-Mail V&
State or County License
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 LAUD INFORMATION:
DESI ENGINEER: _ Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address:
City: Address:
State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY:
Name: — Not Applicable
Address: Name;
City: Address:
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, vyalls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to �e `rd a Notice of Commencement may result in paying twice for
improvements to your rty rice of Commencement must be recorded in the public records of St.
Lucie County and post d h jo e before the first inspection. If you intend to obtain financing, consult
._
with lender or an att r r . mmencing work or recording your Notice of Commencement.
Signature of
STATE OF FL
COUNTY OF
Ider as applicable
Sworn to (or affirmed) and subscribed before me of
this -115 day of I1 c r CA_ , Zo LZ by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced
(Signature of Notary Pub
State of Florida)
Commission No. ( G ga� (Seal)
REVIEWS FRONT ZONING
COUNTER j REVIEW
DATE — r—
RECEIVED
DATE --
COMPLETED
ZPhysical Presence or Online Notarization
'ON'
NA
Notar7 y r olic • State of Florida
Corrrrission » GG 978219
My Corrrr. Expires Apr 19, 2024
r.Lgh National Notary Assn.
SUPERVISOR
REVIEW I VEGETATION S REVIEW REVIEW
MANGROVE