HomeMy WebLinkAboutft pierce permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
c._ LIB LIB -M
L. L` K L L k Building Permit Application
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:
PROPOSED IMPROVEMENT LOCATION: I
Address:
L- (21vcf IPL Sg18Z
Property Tax ID it: 14 It - SOZ - D 00 `f ow - 9
Site Plan Name:
Project Name:
Lot No.
Block No.
DETAILED DESCRIPTION OFWORK: I
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tank _ Gas Piping Shutters
Electric _Plumbing _Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ /if 'You
_ Generator
Sq. Ft. of First Floor:
Windows/Doors
Roof
Utilities: _Sewer _Septic Building Height:
Pond
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name
Name: DoAwi N e^ viM/ 3iyt
Address:
Company:
City: State: _
Zip Code: Fax:
Phone No.
Address: pt!b l L S. L 0 S
' G
City: � at �� fn( State:_
Zip Code: 3 yi Y z Fax: T47
Phone No 772 - C-t of - O 19 7
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail Mgf6 } a6A W #-c V bfd (J Cwve,01-. AA
State or County License
it value of construction is zbuu or more, a RECORDED Notice Ot Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Not Applicable
Address:
City: r 4 State:
Zip: �4ga0 Phone o • 7751
FEE SIMPLE TITLE HOL&R: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE CQ ANY: Not Applicable
Name:
Address.
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:_
Zip: hone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that noworkor installation has commenced prior to the issuance of a permit.
which is inOconflictawith es any representation
ppll able lHome Owis ners tAssociationl rues dbylaws or the covenants that may estrictbor 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 attorney before commencing work or recording our Notice of Commencement.
1 �zKJ
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF S-r LU4Z
STATE OF FLORIDA
COUNTY OF ! Tj 4-6(6w
S�ofl to (or affirmed) and subscribed before me of
7�•
Sw r to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this -2. &day of A U A,(- 2020 by
�Ph sical Presence qr
this
Online Notarization
day of �.l
U+}G • 2020 by
,"acod1 C
-- %iQfi0
1a-6 KS
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known
OR Produced Identification
Type of Identi jc i
Produced (✓S -
Type of Identifi 'on
Produced V111111I
(S
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(Signature of Notary LLIAMS
L
'���'•, -State of Florida
(Signature of N
L qMS
Notary Public
Commission No. _'g 2 ComrrliaYPP » 0G 931632
is My Commission Expires
`�y,p,`y - y
y F-Notar Public -State of Florida
Commission No , ° iasion M ($ 2 1632
November 13, 2023
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'1,40"
My Commission Expires
November 13. 20:
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REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
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DATE I