HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Numbe
- Building Permit Applic;
Planning and Development Services
Building and Code Regulation Division Commercial_
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
JUN 04.2020
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St. LUCi2 County, (=L
I. PERMIT APPLICATION FOR: ( y men j t-
Address: v ,S OLQ (
Property Tax ID #: 3 ✓ a -
Site Plan Name: �f\CCt' �[
ProjectName: e!n
71 f--- To Cock
New electrical Meter n+ rN Second Electrical MeterNI
Lot No.
Block No.S
Additional work to be performed under this permit - check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors _Pond
_ Electric V Plumbing _Sprinklers _ Generator _ Roof I/ Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: _Sewer _Septic Building Height:
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Name,-..Z 0n AN yjD`
Name:
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Address> 'hf r cs D( +F t�SL
City; Qo�f'"Sinn+`%7:LVr, State:
Zip Code: u 9,S1 Fax:
Phone No. i ot�- (�-8_3 n)
Company: �- "ft ,rv� TQA.5
Address:1413 At h 4A,r �Ve.
City: Da solA State:
Zip Code: 3yQ �i Fax:
Phone No
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail FO t o V
State or County License r
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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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _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 of Commencement.
Si ture o Own /Lessee/C ntr r as Agent for Owner Sign ure o o tractor/License
S LORIDA S F FLORIDA
COUNTY OF .
—_ LSO COUNTY OF �� \_\CS�3
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presence or Online Notarization O hysical Presence or Online Notarization
this 9,c� day of 2020 by this qday of 2020 by
Name of person making statement. Name of person making statement.
Personally Known 0z'_-OR Produced Identification Personally Known 03 OR Produced Identification
Typ of Identification Type of Identification
Produced Produce
ti 1 M rte.
(Signature of Notary Public State of Flori ) (Signature of Notary Public-Stat of Flo
ojp y,� Ariana Veneziano of y Anana a eziano
Commission No. Q ° NOTARY(§WIC Commission No. Q NOTAR��pU LIC
c _STATE OF FLORIDA STATE O P%L RIDA
2 Comm#GG185914 ; z Comm#GG185914
INCE 19� Expires 2/14/2022 O* E 19% Expires 2/14120
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
iev. 5/6/20