HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED //��f—j
Dater Q� Permit Number: ( lJ l - 0
RECEIVED
{{►'_ 0 8 2020
Building Permit Application ST. Lucie County, Permitting
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
U
Address:_ gD Z K�►/oL v/cf I re.CL
Property Tax I D#: / ��� �D� 5�'/'/ Lot No.
Site Plan Name: Block No.
Project Name:
New electrical Meter Second Electrical Meter
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:$ Utilities: _Sewer _Septic Building Height:
t1ltfER��ESSEE` i 3
G�}NTEACTQ
Name eMF� ' Lc,v r!d h Name: Al V, E Gr.�ertsK l✓
Address: �J 2 k< G�✓C, T✓'ac-t- Company::
City:' �$L h.l- State: Address: -zl1'l S�.V Tr �o �k
Zip Code: '3 Fax:._' City: ! S L . State:
Phone No. ,� 19 Z �6 .3 �0 0 V Zip Code: Fax:
E-Mail: Phone No 7?t 4/0 7734 In
Fill in fee simple Title Holder on next page (if different E-Mail u M h 1,h V I P? • C-0
from the Owner listed above) State or County Licens E'F G I�z &3a 6
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.
6 ..
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address:
Address:
i -
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.
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 toyour property:A-Notice of Commencement must be recorded in the public records of St..
Lucie County and posted o the jobsite.before the first inspection.if you intend to obtain financing, consult
with lender or an r before commencingwork or recording our Wbtic f Commencement.
Signature of Own tA
ssee/Contractor as Agent for Owner Signature of Co or/License HolderSTATEOF FLORISTATE OF FLORIDA ,
COUNTY OF . L✓UO,1�_ COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
_ppysical Pres nceor Online Notarization Rhysical Pre ence or Online Notarization
this day of \ 20ZO by this day of U 20 by
Name of p s ma ing statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced. ! .
l\ .
AA
of Not
(Signature (Signature \\Illl/, KAREN S. NIELSEN
\",yP KAREN S. NIELSEN r"e'',
�\ Pry . .tio� .
P U°` :State of Florida=No ublic _Sta.te of F.lori pay Public
Commission = �Sea� Commission No. = mmission'Gr;•207484
ion # G 20. 484
OF FPO` My Commission Expires ��;,rFOFIf`ow; My Commission Expires
11I11\1\ .
REVIEWS FRONT ZONING .SUPERVISOR PLANS' VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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