HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST E—L MPLETED FOR APPLICATION TO BE ACC. D
Date: '21-70 [L-t Permit Number: (:�faosm(o
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Building Permit Application
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Planning and Development Services Pe
Building and Code Regulation Division Commercial Residential )e
2300 Virginia Avenue, Fort Pierce FL 34982 1
Phone: (772) 462-1553 Fax: (772) 462-1578 CI DGFunding
PERMIT APPLICATION FOR:
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Address: 5';:z-0 7NJQr I3I-
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Lot No. � Ly
Property Tax ID #:.3Lfo -;
Site Plan Name: Block No. 'VJA-
Project Name:' �,ad
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New Electrical Meter 141ih- Second Electrical Meter-,*O/P- (Affidavit required)
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Additional work to be performed under this pert it- check all that apply:
Mechanical Gas Tank Gas; Piping Shutters Windows/Doors .4--pond
Electric Plumbing S pr I inklers Generator Roof Pitch
Total Sq. Ft of Construction: tt C> Sq. Ft. of First Floor: 'Z!J T)
Cost of Construction: $ :gaq, 00 Utilities: —Sewer _Septic Building Heigl4:
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Name: ot'i
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Address: < -7 0
Company: --'IA-
City:z,-'L State:F'(-
Address: 114-
City: frAn: State:
Zip Code:Fax:,
Phone No. E-
Zip Code: eJ / A- Fax:
Mail: ail yex- kc-m.,Ag2J!kk %V460, (e>wAA
Phone No P.J&
Fill in fee simple Title Holder on next page (if different
E-Mail P1 IA -
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from the Owner listed above)
State or County License tVIA-
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.
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DESIGNER/ENGINEER:
Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name: eCl= 0,44 ,_
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Name:
Address: /v),,a,
Address:
City:. /✓/-
State:
City: -
State:
Zip: Phone
Zip: ___ -- Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY:
_"—Not Applicable
Name:
Name:
Address: _---
Address:
City:
City:
Zip: Phone:
Zip: Phone:.- I
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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, 11 do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Builds , g 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 befdre the first inspection. If you intend to obtain financing, consult
With lanrlar nr ;4n attnrnev hefnrP cnmmencWg work or recording vour Notice of Commencement.
Signature f Contra o - or -Owner Builder as appli file
STATE OF FLORIDA
COUNTY OF
Sworn t (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this day of , 2Q79;�by
Name of person making statement.
Personally Known Produced en ification�
Type of Identific ion du ed
GLAS
(Si re of Notary - S of Florida) p�m Notary Public, State of Florida
z Commission# GG 939909
expiresFeb- 25,2024
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Rev 10/12/21