HomeMy WebLinkAboutBuildingPermitApplication-Leveridge-02June2020All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Permit Number:
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 Residential ✓
PERMIT TYPE: 5 tral I 5 h td
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID Al io - 50 - of Lot No.
Site Plan Name: L A Ili 3 o CO • Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
Su r' r 1,� S �e� h 3vO•Qo � h
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters r Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Plsmti�0"O"-In-L L Name:
Address: Aigo riel5 + 103 Company:
City: L; k- nr. io n State: �r Address:
Zip Code: Mom II Fax: City: State:
Phone No. $5G - Aa -4 -3 -1o0 Zip Code: Fax:
E-mail: ,b(i one 31onagnt;I. "ohn Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) State or County License
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC Is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: ✓ Not Applic
Name:_
Address:,
City:
Zip:
Phone
State
FEE SIMPLE TITLE HOLDER: ✓ Not Applicable
Name:
Address:
City:
Zip: Phone:_
MORTGAGE COMPANY:
,, Not Applicable
Name:
Address: State:
City:
Zip; Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip; Phone:
_,_/ 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
structure. Please consult withpyour applicable Home
Owners Association Owners and Association
your deed bylaws or f covenants rictions which may apply. restrict or prohibit such
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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENV
4f I -' 0
Signature Owner/ lessee/Contractor as Ag4'nt for Owner
STATE OF FLORIDA
COUNTY OF SI-.
The forgoing instrument was acknowledged before me
this a^day of 5vi^4e 20 AO by
Name of person making statement.
Personally Known
Type of Identification
Produced Tj
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this , day of _ J 20_ by
Name of person making statement.
OR Produced Identification Personally Known OR Produced Identification
Type of Identification
Produced
(Signature o otary Public -
Commission No. G-%QSi'IFc
REVIEWS FRONT
i COUNTER
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/1/19
d QQuery r ( nature of Notary Public- State of Florida }
Edna Gomel
MY Gprrwra" al GG 34073
-::0 dY(Si<�q}Rsa 7rzoxt_ _ _ 14o mission No. (Seal)
ROEVIEW SUPERVISONING R
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