HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date- Permit Number: C4 0 Ch I S
ST. LUCI
Building Permit Application
Planning and Development SffWm
Building and Code Regulation Division Commercial Residential vl_�
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR: LA-1 G)J V/�
- A,T- "
PROPOSED IMPROVEMENT1,0—COk
Address: va, <7o
Property Tax ID#: –7?V 0.2 0 42 Lot No.
Site Plan Name: Block No.
Project Name:
1-
'DESCRIPTION'6 'bitAILED' F W�6RKZ'
/U e, 411
New Electrical Meter Second Electrical Meter
CONSTRUCTION *'-
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: Sq. Ft of First Floor:
Cost of Construction: 00 Utilities: —Sewer Septic Building Height I
OWNER/LESSEE1
, CONTRA'i
Name Name: �w
Address: Company: —
CRT State:r l Address: iklq
Zip Code: Fax- City: Stater
Phone No. �A%–4 1 Zip Code: 'a 44 t9,9_ Fax:
E-Mail: a 12 r i P e<2 A,:;4 Y, Phone No
Fill in fee simple Tale Holder on next page if different E-Mail
from tate Owner listed above) State or County License
If value of co,nstniction 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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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.
1 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 requester)permit,I do hereby agree that 1 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.
Signature of Owner Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF A i nk /y i 4��— COUNTY OF
Sworyto(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Prese or Online Notarization Physical Presence or Online Notarization
Js day of 1�1
� 2020 by this day of ,2020 by
1Y > n
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
4
(Signature of No Public-State of Florida) (Signature of Notary Public State of Florida)
tYP� AUDRE e��{E4IPHREY Commission No. (Seal)
Commission No. = COMMIN #�GG 300817
Pg= EXPIRES:March 6,2023
"ild"Him Notary rul ac unaerwnters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
JDATE
COMPLETED
Rev-5/6/20