HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: C �� " Permit Number:
i LUC1L
Building Permit Application
Planning and Development Services
s
Building and Corte Regulation Division Commercial Residential T�
2300 Virginia Avenue, Fort Pierce FL 34952
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address:_�3
Property Tax lD #: & ';�-- `�06 r b (j -St- ' o oQ - Lot No. ` 0
Site Plan Name: RTC i� C� tom(li rk� Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank L-'6-as Piping _ Shutters Windows/Doors Pond
Electric Plumbing —Sprinklers Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 9Clk t4c) • ® 0 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name_
Name:
Address.'� �. C)CtI e-., Auk— k
Company: Lie �-
-P
City: Ve3 State: '
Address:1�10()�c`�Ztl�C7
City: C.�- f\ +rL.°T State: C -
Zip Code: Fax:
Phone No. E-
Zip Cade: -3kA"-N � Fax:
Mail:
Phone No ) �)-- '-3Q D u l u
Fill in fee simple Title Holder on next page (if different
E-Mail n-e to-
State or ounty License_ _Q C C�i j )
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
Name:
MORTGAGE 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_
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.
Lucre County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attoroeV before commencing work or recording our Notice of Commencement
AA
Signature of 6ritractor - or -bw^ftr Build as applicable
STATE OF FLORIDA
COUNTY OF I f,ax 10
Sworn to (or affirmed) and subscribed before me of
P�/ihysical Presence or Online Notarization
this day ofi 20by
Name of person making statement.
'NM'EX
S�dPIRF
Personally Known ZOR Produced Identification � ci.����`�3 2°23
Type of Identification Produced
Q
:gam ��.90C'� Z
(Signature of Notary P State of Florida)
Commission No_ Q0!?(9 (Sea[)
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Rev 10112121