HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a�a� Permit Number;
Building Permit
Planning and Development Services
Building and Code iiegulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
::.-...:5 �ti:� ��-� Cam.,✓
JUN 03 2020
trrnitting D.ipartrnent
St.. Luciel—Ounty, FL
Property Tax ID #: / 0 / -34Y '00cQ0 -OOD -J Lot No.
Site Plan Name: QQ Block'No.
Project Name: TU le -Ban Q
New electrical Meter
1.
Second Electrical Meter CK�
Additional work to be performed under this permit- check all that apply:
_Mechanical
_ Electric
_ Gas Tank
—Plumbing
—Gas Piping
_Sprinklers
Total Sq. Ft of Construction: 100
Cost of Construction: $ • 0�
_Shutters _Windows/Doors Pond
Generator Roof Pitch
Sq. Ft.� of First Floor:
Utilities: _Sewer _Septic Building Height:
QU►�bfER�LESE-K
Name inizs-r ky\c2. Sif'K'el(^
Name:,.
Address: 'S2(a0 TO P -��
Company:
City: C%C, g\QXCe State: rL
Zip Code:; CO- Fax:
Phone No. a�oi4�_ % ^o�Dl `19
Address:
City:',-,-- """ State:_
Zip Code: Fax:
Phone No
E-MaiI:GS�riKet SO�iG�\yj�,t�
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is requirea.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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01
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ 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 issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holderto build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that rray 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 Twill; 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 anottfW'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 y6u intend to obtain financing, consult
with lender or amattornev before corrimencing work or recording you r,Notice,of.Commencement..
Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder'.
STATE OF FLORI ,i STATE OF FLORIDA
COUNTY OF Y• i lLa e COUNTY OF
Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
! Physical Pre, ce or. Online Notarization Physical Presence or online Notarization
this�d'ayof,5,,,ro.2O-Vby this _day of ,20_by
Name o erson making statement. Name of person making statement.
Personally Known OR Produced Identification V-- W DI
Type of Identification
Produced
(Signature of N
;u•�"(• •••:,•. REYB.H M Ey
Commission No.
a; ;,; MYCOMMISS �M G300817
'•`
XPIRES: arch ,2023
Banded Thru Notary Public Undemriters
REVIEWS
FRONT
ZONING
SUPERVISOR
COUNTER
REVIEW
REVIEW
RECEIVED
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary.Public- State of Florida )r
Commission No. (Seal)
PIANS, _ VEGETATION SE,ATURTLE• MANGROVE
REVIEW REVIEW- REVIEW REVIEW