HomeMy WebLinkAboutBuilding permit application � I
All APPLICABL INFO MUST BE COkIPLETED FOR APPLICATION TO BE ACCEPTED
Date: W Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
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2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
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PERMIT APPLICATION FOR:
P
Address: s
Property Tax ID#: Lot No.,
Site Plan Name: Block No.
Project Name:
II
D { DD=P fa)NO � R .
New Electrical Meter Second Electrical Meter
Q S U Q Up
O A ION;
Additional work to be performed under this.permit—check all that apply:
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_Mechanical _Gas Tank _Gas.Piping _Shutters _Windows/Doors _Pond
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 440 0 Utilities: —Sewer _Septic Building Height:
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OW ER/LES- E «DNTRA TC+1 .
Name j(A r'j V EZAR:50 Name: II
Address: ` �� LSRM T)12 Company:
City: I�e-r'R E{2.e:4r,-7 State-4_ Address:
Zip Code: 3498 2- 1 Fax: City: State: f
Phone No. 7a e, '0) 7 c� Zip Code: ' Fax:
E-Mail: T� P Jr� i�0 C � COQ 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.
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� .- EME AL CON- CTION1011CN W INF• R ACK
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 pern)t fo 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 attorne before commencing work or recording our Notice of Commencement.
Signati.Ve of Owner see/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFCOUNTY OF
Sworn to(or affirmed) and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presence o Online Notarization' Physical Presence or Online Notarization
this�day of 2020 by this day of 2020 by
�>�
Name of person making skatement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification ,
Type of Identification Type of Identification
Producedi✓� 6 L Produced
�0a�
(Signature - -^-f€ (Signature of Notary Public-'State of Florida )
� ELLEN VAUGHN
Commissio " a-';State of Florida-Nq&3vlpublic Commission No. (Seal)
=* *= Commission # GG 270079
9.F oQo My Comrriission Expires
11 m
REVIEWS FR `NTS` fON1NG SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW 'REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 5/6/20