HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED, FOR APPLICATION TO BE ACCEPTED
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Date: I Un K "o
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JUN 0 v 2020
--- -- Building Permit Application
Permitting DPI"arrment
Planning and Development Services
Building and Code Regulation Division Commercial Re ide$'tial•ucunty FL
2300 VIrginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITAPPLICATIONFOR:
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Site Plan Name: Block No.
Project Name:
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New electrical Meter Second Ell e ical Meter
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Additional work to be performed under this permit— check all that apply:
_Mechanical Gas Tank Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: 1717 Sq. Ft. of First Floor:
Cost of Construction:$ . o0v Utilities: _Sewer _Septic _ Building Height:
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Name VIQ haY a Y- Name:
Address: (P4% W - Werbee Vel Company: `-
City: ifrct, Stater Address:'-
�[r� City:; State:_
Zip Code: 37-1IQa. Fax:
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Phone No. 70ob- 9— O�,µk Zip Code: Fax:
n33
E-Mail: �4VF li INi5N, Co Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) State or County License
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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MORTGAGE COMPANY: _ Not Applicable
Name:
DESIGNER/ENGINEER: T Not Applicable
Name:
Address:
Address:
City: State:
Zip: - Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 issuanm 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 covenant's that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed'for any 'restrictions which mayapply.
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 t9lorrrproperty. A Notice of Commencement must be recorded in tiie public records of St..
Lucie Coupx9►afid Post d on the jobsite before the first inspection. If you intend to obtain financing, consult
with IendPf _dr a n nev before commencine work or reco'rdinevourNotice,of Commencement., '
Sig re of Owner/ Le ee nt actor as Agent for Owner
Signature of Contractor/License Holder
ST, OF FLORIDA
STATE OF FLORIDA
C(JUNTY OF. fi/.Lri
COUNTY OF
Swo�a to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
i/ Physical Pr ,nce or_Online Notarization
Physical Presence or Online Notarization
this day of 20 ° tby
this _ day of 20_ by
r2on 1C1 fl�arOL4 kars0k
Name of person making stateme ,
Name of person making statement.
Personally Known OR Produced Identification
Personally Known • OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of No Public -State of Flori ) .
(Signature of Notary, Public -State of Florida')
Commission No. ::ai+.':"•••, AlDREy�. f�'HRF
Commission No. �' 'r(Sea[)
;? MY COMMISSION R GG 300817
EXPIRES' March 6, 2023
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REVIEWS
SUPERVISOR
PLANS
VEGETATION.
SEA TURTLE.i,
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW.' "
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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