HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ,e
Date: Permit Number: c1 7'o ( i
RECEIVED
NEJUL 0A) li 0 D
Building Permit Application ST. Lucie County, aerrpig ,F,
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:
Address: , �o 1T,0A41u4 D
Property Tax lD#: Lot No.
Site Plan Name: Block No.
Project Name: C h'd x-./ L(I t✓
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:'
Ad21ditiechanical
nal work to be performed under this permit-check all that apply:
—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: $ �j_ s of b® Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name: hewm ,,0 T4`
Address: 0 JW JJ 9 , 4i'A Jot- Company i-I-AI I.S Ap..41AJC ,0,�-
City: State:_ Address: /6 l/La,�kSA s Jam.
Zip Code: Fax: City: ,mil'- 0/-e4c- State:-/-
Phone No. Zip Code: � �� ) Fax: /I/�X
E-Mail: Phone No 17,4- -- Z- U
Fill in fee simple Title Holder on next page(if different E-Mail I- �� GJr1
from the Owner listed above) State or County License_448036506 0 2.02
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 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
wit4 lender or an attorney before commencing work or rec9rding your Notice of Commencement.
Signature of Owner/Le see Contracto Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 1 . �',(�,��. COUNTY OF t'- .
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presence or Online Notarization Physical Presence or Online Notarization
this day of 2020 by this day of 2020 by
Name of person making statement. Name of person making statemen
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
1 0 AA
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Commission Commiss
•�ZpRY PV�� N S. N EL EN ,��"YP'�% S. NIELS N
St
ate of Florida-Notary Public ;i°`� Ua�=State of Florida-Notary Public
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0 ��°c My commission Exp res i9� °P My Co mission Ex ire'
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