HomeMy WebLinkAboutBuilding permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Building Permit Application
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: 'T h ci n Ander,50?1
PROPOSED IMPROVEMENT LOCATION: Address: S �_o t�_ 4-.;P11n h r ?�' �//
'a . hsl_ i 061f.-il-A
Property Tax ID #: �16,� - �& - 603� - UQ0' % Lot No.
Site Plan Name: Block No.
Project Name: / !1 r7CPSS e h O
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
/—Mechanical _ Gas Tank _ Gas Piping AShutters
vElectric 14lumbing _ Sprinklers
v Windows/Doors _ Pond
_ Generator _ Roof Pitch
Total Sq. Ft of Construction: [ Sq. Ft. of First Floor:
Cost of Construction: $ ff SPe' a q('/1MS Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 764n h rv6 n
Address: y6�6 Ore(, n D yd
Name: 9 U S ,1 a
Company: 4 lC At-e-t6 > 1
City: w-'n CC State: FL
Zip Code: 3Y�1 Fax:
Phone No.
E-Mail:
Addres : 3 /I1l cac /A
City: ,7r h State: %�-
Zip Code: 4.0 Fax: SO f
Phone No 5 �/"I gq%-
E-Mail Lev Cp/+ art G . e 4 ,,A
L
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License C 0 �e
.1 .0 Va V1 a.V11au Vfd,IV11 ib cwv or more, a nrLUKUtu notice or 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
Name:
Address:
City: State:
Zip: Phone
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 attornev before commencine work or recording your 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
COUNTY OF
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 statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/b/LU