HomeMy WebLinkAboutBuilding Permit Application -All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: '
-Permit Number_.
0
D ° _Building Permit Applicat on JUN X020
Planning and Development Services .`' i`i '- `s 1 i IT e n.�-
Building and Code Regulation Division COI71m.6rcial Residential-i A,i} "5/__F11 I
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION.,
Address: 171
Property Tax ID#: 3 I1 _ Lot No. Q(3
Site Plan Name: Block No. 1
Project Name:
DETAILED DESCRIPTION"OF WORK:
w;
I tJS-�,n,.\� l�� 7(l�. ��c-it�l r` Sib ls.�� �'�fC��� �^z�r��T►'�� `1 � `�-Qllt�a�-(>, �''r.���i�I�
�j��C'ZS r .� 141�� `err ii l-1 iC<< G>b®�s �� fLvvltkdCo�C �t3fL {- �v�
New Electrical Meter Second Electrical Meter 'rlbtplt�-�2
[,CONSTRUCTION-INFORMATION.
Additional work to be performed under this permit-check all that apply:
Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Pond
ctric Plumbing _Sprinklers _Generator _Roof Pitch .
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ e,[ Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: 1.,1 CONTRACTOR:
Name' Name:
Address: :1-72 Q Company:
City: L .1` LkLiL State:�Pl Address: SY041 Nil � wT1�
Zip Code: 34135-2— Fax: City: . Ck, C-e2(_C Stater
Phone No. Zip Code: ,,�4 GIS ( Fax:
E-Mail: Phone No 7 2_--5-7`7
Fill in fee simple Title Holder on next page(if different E-Mail IP u.5 • '�14
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.
SUPPLEMENTAL CONSTRUCTIONII,EN LAW INFORMATION
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 lender or an attorneybefore commencingwork or recordingour Notice of Commencement.
Signatur of O v KWe We'l ract gent for Owner Sighature a ContrWofticense er
STATE OF FLOT'nA, STATE OF FLORID
COUNTY OF It to c COUNTY OF
Sworn to(or affirmed)and subscribed before me of Swrgrr't (or affirmetd)and subscribed before me of
✓Physical Presence orT Online Notarization. L �sical resen'ce or Online Notarization"J p
this `I q- day of I\g _ 2020 by this=� day f L-Uu�—�--2020.-by f
Name of person making state nt. Name of person making.statement. r
Personally Known OR Produced identification Personally Known OR Produce entificationY _
Type of Identification Type of Identification__
Produce Produced
'�M�
(Signature of Notary Public-State of Florida) `— (Signature of110 FF998825
��j lo�j(�� '°,, {; PIIRES June 05 ?0'20
Commission No. Publiic Steffi of FWWa Ommission No. ao 1396 O7�3 l rldallotaryS
Evelinda Flores
My Commission GG 383182
d!F
REVIEWS FRONT ^tbftf4t^1kWPLANS VEGETATION SEATURTLE MANGROVE
COUNTER IREVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE b6dx-
RE
CEIVED DATE .
COMPLETED
ev.
AA