HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia A venue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address:.
Property Tax ID It: S 6 - 00 5 ZS • CDC) O `:D Lot No. _
Site Plan Name: ' S I't"- -c) P( fi T '+- C) ti c Block No.
Project Name:�11ii�+�cC� '^
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
(Affidavit required)
Mechanical was Tank 1'Gas Piping Shutters _ Windows/Doors _ Pond
Electric ____ Plumbing — Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction.
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: —Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 1 i0 S i k i V\A
Name:
2i='C� N I
Addr
Company:
, c�
City: R�-O':> P StateT-L--.
Zip Code: U'Q (P fax:
Phone No. E-
Address:'
City: �L-At 'P� yz
Zip Code: Fax:
Phone No
E-Mai D iop 01Y)
State or County License
State: r�
QU I
P& K Cd
Mail:
Fill in fee simple Title Holder on next page (if different
from the owner listed above)
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 LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable 7MORTGAGE
Name:
COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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-
1 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 Count�nd posted on the jiobsite before the first inspection. If you intend to obtain financing, consult
with lender or n attor0ev befor i commencineF work or rernrding vnHr Nntirp of (-nmmpnramnnt
i
Signature of Copt actor - or -WrBuiderA2s applicable
STATE OF FLORIDA
COUNTY OFAl) �-
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this day of f 20 by
Name of person making sta meet.
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Personally Known OR Produced identification,,,Nx\1
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Type of Identification Produced
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(Signature of Notary Public- S to)Df Florida)
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Commission No.(Seal)
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REVIEW
REVIEW
REVIEW
DATE
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DATE
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COMPLETED
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