HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST
BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �D' �(� 1 Permit Number: ;?-Do7�(7�j�
��o dUCUIE 2z RECEIVED
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Building Permit Application JUL 0 0 2020
Planning and Development Services ST. Lucie Cou , Permitting
Building and Code Regulation Division Commercial Residen
2300 Virginia Avenue,Fort Pierce FL 349.82
Phone:(772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
Address: Z CIY
Property TaxID.#: � J '— ��� 'd! �— �`-17 Lot No.
Site Plan Name: Block No.
Project Name: .
v Ike Y
j x �/
New Electrical Meter Second Electrical Meter
COON + I FOR O :
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors Pond''
Electric _Plumbing -Sprinklers _Generator. _Roof Pitch'
Total Sq. Ft of Construction: //'Z Sq. Ft. of First Floor:
Cost>of,Construction:$ MOO Utilities: _Sewer —Septic Building Height:
ER �-S �E• eO TR OR:
Name i =`' d `y Name { yD'�C. IS A
2 ,', .
�i Company: r�OY/a�f' (� uJ Address:
City: r' Cp/ram LUGJ$ State:)C�_L 'Address: /v J rl
Zip Code: 3 '� � Fax: City: Or-4 r El'�rc State: z -
Phone No. Zip Code: 3 V 9 7 J Fax:
E-Mailr'G y13UA/� (1j01i� Phone No 7 7 Z 3-3 3 3 3
Fill in fee simple Title Holder on next page(if different E-Mail p G�ouJ G 0 ti,
from the Owner listed above) State or County License n I
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.
SUPPL �N L CQN UCTR(INALIC N LAW I;N'FO MATRON:
I—— - -NN
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: Stater 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 attorney before commencing work or recording our Notice pf Commencement.
o C/Lad
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Alder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ' 'V- LL)C73C COUNTY OF S' t. (—uc; C
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed) and subscribed before me of
✓Ph sical Presence or Online Notarization ✓ Physical Presence or Online Notarization
this day of Ato-C, 12020 by this day of 14 „ 2020 by
Name of person making statement. . Name of person making statement.
Personally Known OR Produced Identification I, / Personally Known OR Produced Identification t'
Type of Identification Type of Identification Jahira Sanchez M fina
Produced Produced NOTARYIPLIELIC
�r y JahiraSanchez-Medina o STATE OF FL DA NOTAR PUBLIC
�; ?Comm#GG36 7 8
(Signature of Notary Public-State of Florida �)!Z:cI%TE 'T a of Notary Public-State of Flori I'0 Expires 8/7/ 0
!-22 omm# G 6 708
Commission No. & 307,0b (Seal)y�f�g1� Expires WaMsion No. �7 �.5?CMG (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20
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