HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: +� �+ Permit Number: -
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BUilding Permit Applicatio
Planning and Development Services la'L'
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Building and Code Regulation Division Commercial ReSit�e11b81.�-'
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR: r�V D W
PROPOSED IMPROVEMENT LOCATION:;;
Address:
Property Tax ID#: 3A) Ci f �' {�� 7 Y Lot No.-at
Site Plan Name: �W\,N Block No.
Project Name:
4 DETAILED DESCRIPTION OF WORK:
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Pak
00 �T a J e t—0
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New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit–check all that apply:
_Mechanical i Gas Tank __Gas Piping u Shutters _Windows/Doors ,Pond
-Electric _Plumbing Sprinklers Generator Roof Pitch
Total Sq.Ft of Construction: Sq.Ft. of First Floor:
Cost of Construction:$ r ? Utilities —Sewer —Septic Building Height:
OWNER/LESSEE: ,h? I, ` CONTRACTOR:
Name Name:
Address: oG \v\wc Company:° :Cc
City: Stater Address: C/p "� "0
Zip Code: Fax: City: Stater
Phone No. �-- �1'� Zip Code: __�q9i S I : Fax:
E-Mail- 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 HAVC is$7,500 or more,a RECORDED Notice of Commencement is required,
SUPPLEMENTA"''CONSTRUCTION:UEN`LAW INFORMATION
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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 TITLEHOLDER: __._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 lendan attorneybefore commencingwork or recordin Notice of Com encement
4gnaturewner/Less or A nt for Owner ignature Contra r e
STATE OF FLORIDA STATE OF FLORIDA J,7
COUNTY OF A . UC i e. COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
✓ Physical Presencg or Online Notarization — �,y5�cal Pres nce or
Online Notarizatio i
this 22-dayof June 2020 by ,,this dayof"' 3- ri 2o2Q.by
t A' /}
I.Q.S S`etk !�c�-y -"� ci � -� d P4-�
Name of person making statement. Name of person makingstatement. /
Personally Known ✓ OR Produced Identification Personally Known V/ OR Produced Identification
Type of identification Type of Identifica i�Gn
Pr ad d Produced ; 4
(Signature of Notary Public-State of Florida j (Signat6t e,. pp{F�nary P�,��,^ sl`'�(%0 ° V l
1407)390.01 3 t 1}(,aFua�Idq�cgary$prujpexom ,
Commission No. 6 �— e ry Public Stain of
�( O ISSIon NO. a �� T" —j3eal)
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Evelinda Flores
My Communion GO 3831 2
o►tti Paras
REVIEWS FRONT S VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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