HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE.COMhr i cD FOR APPLICATION TO BE ACCEPTED
Date: � Permit Number: ,�y !!bD 3
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RECEIVED
Building Permit Application
JUN 17 2020
Planning and Development Services ST. Lucie County, Ppmitting
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:
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Address: J
Property Tax ID#: 3 `� 5 \� �� �3'�" d�–a Lot No.��
Site Plan Name: q Block No.
Project Name: v
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New electrical Meter ✓ Second Electrical Meter
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Additional work to be performed under this permit–check all that apply:
Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors _Pond
Electric Plumbing _Sprinklers _Generator _Roof Pitch.
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ �, (7��J Utilities: _Sewer _Septic Building Height:
QUIt N ER/LESSEE ' CQNTRA Q R 9 li .
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Name R`'.L�i:�`<�, , : _.;r Name, fib a
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Address: "i10�S.S..�:r.�..,; :` �:L Company; =Q, _ vl
City: -N)-�={'a.-:;� a c. `` State: L Address:
Zip Code: 3a.��3 Fax: . .-- 'City:wrl :. � 'ICJGte7. L' State: L
Phone No. :Zip Coder '3`{ 'S• :..:' ::,: Fax:
E-Mail: Phone No 4-a (10
Fill in fee simple Title Holder on next page (if different E-Mail 'aeTV•C,e ✓ vl .uri5GU r caV"
from the Owner listed above) State or Count License a g
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: -'Name:
Address: 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:
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 l 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
wit 'lender or.an attorney before commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder .
STATE OF FLO�tIDA STATE OF FLORIDA
COUNTY OF s� - L c COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presence or Online Notarization Physical Presence or Online Notarization
this�'L day of T oyr 20 a4 by this \Aday of Zry he, 20_%L by
\r,ovc-. 6 w.a sy c��c' a J �, f t�,.n.as
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced L I— Produced 5-1- i
(Signature of Nota Public-State of Florida). (Signature of No sM Stat®r>�WWf .
=� MYcOMMISSION GGQ22023
Commission No. �r{7t� Nr MpRI#G00,�023 Commission No. ,e `owTh Notaery r1 12020
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MY COMMISSION 16,2020
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REVIEWS FRON RVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNT REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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