HomeMy WebLinkAboutPermit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Permit Number:
LUC s ....
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`" 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:
• .. -
L' mkcryk0irp- Block No.
Project Name: "�N5- VOL
I DETAILED DESCRIPTION OF WORK: I
1. t\\iI l. ,l t" . ,Mal 190 . . , ' � I � c
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical
✓Electric
Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ S"�6 70 •
Gas Piping
Sprinklers
_Shutters _ Windows/Doors _ Pond
_ Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name �)fn�5f-' L- Tie-pF—
Name:
Address:,�7)!Qkl p D WQ. 42
Company of � lab'l
Dff S U10-1
City: Yi- p tPX (' Q . State:
Zip Code: ►sa Fax: ---
Phone No. 401- I
Address- i S;uj JoQk
,a NIPS D r 11/ if
City: _
Zip Code: ��^(
Phone No
S `Wtstate.-r�
Fax:
E-Mail: IUIt?C�AI�.0 Wn
�tS
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
aoaln
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State or County Licenseex
t3oOci?)Ig
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 CONSTRUCTI N LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY:
Name: Name:
City:
Zip:_
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
Address:
State: City: _State:
Zip: Phone:
Not Applicable I BONDING COMPANY:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
Applicable
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 attornev before commencing work or recording your Notice of Commencement.
Signature of wner/ Lessee/Contractor a Agent for Owner
Signature of Contractor/License Holder
STATE OF
� �
OF ORIDA N"tin
COUNTY OF
COUNTY OFSTATE
Sworg to (or affirmed) and subscribed before me of
Sworn (or affirmed) and subscribed before me of
Presence or Online Notarization
Physical Presence or Online Notarization
_✓Physical
this day of �iSLX\R . 2020 by
this Ill day of Cl1tJV-- 2020 by
`M0'fMa.0 o t�YS°n
'(h(1.mw QL9IkQmfA )
Name of person making statement.
Name of person making statement.
t1
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Ide �tiftcation
Produced lr i U,P m It o o nS-e
Produced IL�UP
(Signatur of Notary Public- State of Florida)
(Signatura& Notary Public-- StatecofFloricla)
Commission No. ?SGu (pO
n No. IX it X 1 TAY!ORN
TAYLOR A;
.
ONES .. , Notary Public - S
.' Notary Public - St
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to of Florida -. *s`r Commission e
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My Comm. Ea it
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�ontled throe h Nation
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REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Flo�dd
202:
Ass,
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