HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Numbe ,F r Q 1- 7
JUN 0 8 2020
Building Permit i ,c.i tnnle n t
Planning and Development Services ;
Building and Code Regulation Division Commercial Resl 6ti4i _
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
/1� � &d
PERMIT APPLICATION FOR: •J
Address: _7d 3 P2`1_1-1 I 3q S k z.
Property Tax ID#: 34 b 2 Lot No. `�
Site Plan Name: Block No.
Project Name:
�........... `',r�,�'��,
New electrical Meter Second Electrical Meter
Additional work to be performed under this permit–check all that apply:
—Mechanical —Gas Tank _Gas Piping J Shutters ^Windows/Doors Pond
_Electric ^Plumbing Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: 42 _S70 Sq. Ft. of First Floor:
Cost of Construction:$ ,� Utilities: —Sewer —Septic Building Height:
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Name 'bo.0Q S'aMPS n Name:
Address:S703 Myr-Fl"' 'I c 'Company.
city: State: P 4 Address:.
Zip Code: 3 9$ Z Fax
City: State:
Phone No. 70 $,2q gis 3 Zip Code: Fax:
E-Mail: p b ilt (Ah170, Phone No
Fill in fee simple Title Holder on next page (if ifi ere t E-Mail
from the Owner listed above) d1 State or County License
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.
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 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 lende t an attorney before commencing work or recording our Notice of Commencement.-
Signatur o'fown.er/<eis-e-e"-/Codtractor as Agent for Owner Signature of Contractor/License Holder .
STATE OF FLORIDA - STATE OF FLORIDA
COUNTY OF COUNTY OF
Swor to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Pre ce or Online Notarization Physical Presence or Online Notarization
this�day of 20, this day of 20_ by
1 �,
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification `� Personally Known OR Produced'ldentification
Type of Identification 7 Type of Identification.
Produced �;'� Produced
,(Signature of N9yyPubli oar =. (Signature of Notary Public-State of Florida)
AUDR- HUM EY , ,
Commission No. _ BGG 300817
( N&-Ixch 6,20M ommission No. (Seal)
Bondc:'Thr,:Y -.;:!i-,:ivrUndeWters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW 'REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.