HomeMy WebLinkAboutBuilding Permit ApplicationAll 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
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial
CBDG Funding
Residential X}�
PERMIT APPLICATION FOR: ,
Y~r CGYI�f A CC or orl 5VJ\J ors
PROPOSED IMPROVEMENT LOCATION: _
Address:
Property Tax ID #: t t -�5 L4 'SUN (;U?4 } b Lot No. a C7
Site Plan Name: SI(IO�Y�Q1f1 av�tm Block No,
Project Name: Sna On C-uo '�'On
DETAILED DESCRIPTION OF WORK:
1 �1\ Ck b M O 5 G� Cc�rcl i rn, SIn u�t r S n
Char ��n�1
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 Shutters
(Affidavit required)
Windows/Doors — Pond
_ Electric — Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ �jZ2�,�
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR`:
Name'ShNcc 1 C- S')t-yro n
Name: V
Address: C12kci 1��p�
Company 1k" Yr
City:_ ri st �, ��'-e-"t`- Stater
Address: P,
Zip Code:':�vla (.p
City: {�- jY� S-t L(��e State:
1Fax:
Phone No.�L.� �' al -AS IG13E-
Zip Code:3Lk9 $ Fax:
Mail: `(-
Phone No k
Fill in fee simple Title Holder on n page (if different
E-Mail j I ,
from the Owner listed above)
State or County License aL4-pc( j
If VaIuP of rnnMrnrtinn i. 7Cnn ... ....._.. _ nr�•�n.•.�.•. .. _tee__
----- -- ---- -- ...—•.-,.• •••- v••.+..v..• v. a,v�ntRC11l.CItlCnl IS requlrea.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CON
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: Phone
STRUCTION LIEN LAW INFORMATION
Not Applicable MORTGAGE COMPANY:
Name:
Address:
State: City:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
Not Applicable
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 consu t with your Homeowners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, 1 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. considt
with lender or nn nttnrno" hof.,. , ,. _ _:_ _
V�1 11 1 JC:iiLrrIwUFK or recording our Notice of Commencement—
F-Signaturof O ner/ Lessee on actor asAgent for Owner
TE OF FLORJ.QA
COUNTY OF_ , LOC. \-�
Sworn to (or affirmed) and subscribed before me of Physical Presence
or Online Notarization
s thic day of k��y-CVO 20SIDby
? C,- _Q
Name of person making statement
Pers Ily Known OR Produced Identification
Typ of Identification roduced
e of Notary Public-cttate of Florida)
Commission No, , aq�7q �o�n�Y P✓s o ALYSSA A.T. BOWSER
Seal)
* Cemmissien GG 295930
Expires January 28, 2023
°FOFp',C' Bended ThruBudget Notary Services
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