HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address:
V
Property Tax ID #: [-Sol- L l ML - ! Lot No.—
Site Plan Name: w,�4 ! ►t11 l ,:- CXR -f- Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter
Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
Mechanical
Electric
_ Gas Tank
Plumbing
Gas Piping
Sprinklers
Total Sq. Ft of Construction:.)
Cost of Construction: $ , CIC e -D
OWNER/LESSEE:
Name
L
Shutters Windows/Doors _ Pond
Generator
Sq. Ft. of First Floor:
Roof Pitch
Utilities: —Sewer _Septic Building Height:
CONTRACTOR:
Address: (bCg��rlenin J
City: State: !-L
Zip Code: -:K ��-�(��_ Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: &�(ar^t`�Sd�1
Company: pk"MC;5 uL his.
Address: "�;'-k_
City: c Stater
Zip Code: `) cj 1 -- Fax:
Phone No
E -Mail G)waa.1 . fns
State or County License Ma 1
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:
Address:
City: State:
Zip: Phone
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: ^ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
Zip: Phone:
City:
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 is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners 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 County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with fender or an attorney before commencing work or recording our Notice of Commencement.
�P
Signur of Owher/ Less a/Contractor as Agent for Owner
Signa dr-Contractor/License Halder
STATE OF FLORIpA
STATE OF FLORIDA�,, ,•
COUNTY OF t pA LAI%P N
COUNTY OF A fta.4
Sw rn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Prese ce or Online Notarization
this 1 L day of �'1, 2020 by
this day of 2020 by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of ldentificatlof
Type of Identification
Produced
Produced
(Signature of Notary bjw�-§date of FrOVIdS fARJON
Florida
(Signature of Notary P bl+p - to of FloWW1 CARLTON
State of Florica
N3tary Pub`)c State of
Comm'ss�s- GG 32b45fl
Commission No. .�-� y coir , ilai Air 22.2073
i r`. Notary Pubirc
s' Commis ion r GG 326450
Commission No. µy Comm. J�pr 22.2073
3orcec thrau;•" tiationa! Notary Assn.
Bonded thraugh Nations! Notary Assr.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20