HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE 1 FO 6ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r
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Date: O5 VW Permit NumberY `V`�' � ��
MAY 2 7 2020
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Building PermitApplicatiM,Lucie County, Itting
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:
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Site Plan Name: Block No.
Project Name:
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Additional work to be performed underthis 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: AAA 3 Sq. Ft. of First Floor:
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C6st16fCon9ttr ctpn $ Utilities: _Sewer _Septic Building Height:
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Name.
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City: %%L� State: ��
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City: "' ` "'e ` State:_
Zip Code: fB Fax:
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Zip Code: Fax:
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Phone No
E-Mail:—Zoff
Fill in fee simple Title Holder on next page (i different
E-Mail
State or County License
from the Owner listed above)
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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Name:
Not Applicagl=
E COMPANY:•
Name:
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•••Address:
City:
State:
city:
State:
FEE SIMPLE TITLE HOLDER:
Name:
• • • • -
4ONDING COMPANY:•
Name,
Applicable
. • •ress:
Addre
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 of 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,,W;
structure. Please consult wlth,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,.perfomn 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 ilure to Record a Notice of Commencement may result in. paying twice for
improvementsAo your, pi pery}r A -Notice of Commencement must be recorded in the public records of St..
Lucie County and,po a onbb((ppfifie•jobsite before the'first inspection. If you intend to obtain financing, consult
with-fanriar nr an'a n ev efnrp rnminencine work or recording vour Notice of Commencement.
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Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of contractor/License Holder
STATE OF FLORIDA
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_Oniine Notarization
Physical Presence. or_Online Notarization
this _nd'ay of V` s" 120 by
this _day of20_ by
�a,a1 S�.apb,ec�
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 7
Produced
iJ
(Signature of Notary, 9ti
(Signature of Notary Public -State of Florida) ,
R�+ti.•.,, `DEAN I AMARIEGNENS'
_
Commission No.
�M'�I,S1ICN II GG 022023
EXPNiE�December13,2020
Commission No. (Seal)
-'•.,,o�i�$�•' . Bondedilw Notary Public UndenMteis
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