HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE
FOR APPLICATION TO BE ACCEPTED
fs
Date:
ST. LUCIE
WVIIHMTY
F L O R I D A
Permit
Building Permit Appl
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
)LEI
JUN 2 3 2020
On—mitting 1`,�,,r,rtment
St. Lucie County, FL
PERMIT APPLICATION FOR: A4eta:! ('2,.^�d -}-
PROPOSED IMPROVEE,/MENT LOCATION:
��Z
Address: / /-[ UsAn5 C/rC,/c IV, Sc.� 4 Luc,'C
PropertyTaxlD#: Lot No. 3�
Site Plan Name: ° Block No. 14
Project Name:
DETAILED DESCRIPTION OF WORK:
`A� C�dreir�P S/k� �5�01 S 2 Ff
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 _Shutters
_Electric _Plumbing _Sprinklers
Total Sq. Ft of Construction: /S00
Cost of Construction: $ /3DQ0
_ Generator
Sq. Ft. of First Floor:
-Windows/Doors _ Pond
Roof Pitch
Utilities: _Sewer _Septic Building Height: /.3
OWNER/LESSEE:
CONTRACTOR:
Name 6/cnn CSC
Name:
'!�
Address: 5-S-Z/ /-(i 5AA :, Cl:G/c
Company:
City: Po,4- 5a.'•. �- 1 ..erle State: i4(-
Zip Code: 3�/ %fl % Fax:
Phone No. 77Z - `// fr - 3 k 37
Address:'
City: State:_
Zip Code: Fax:
Phone No
E-Mail:fGS/en.l Cd cfqe-a/1
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 required.
If value of HAVC is $1,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE CVANY:
Name: /p /'C /�%so
_ Not Applicable
Address:
Address: 9ZoP JoAeS�-
City: State:
Zip: Phone
City: I%Ie4 � State:
Zip: Z2/0Z Phone: FsSS 3"ai-7os'i
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY:
Name:
_Not Applicable
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
with lender or an attornev before commencing work or recording vour Notice of Commencement.
as Agent for Owner
STATE OF FLORIDA
COUNTY OF (�
Sworp to (or affirmed) and subscribed before me of
V sical Pres a or Online Notarization
this day of 2020 by
e of person making statement.
Personally Known OR Produced Identification ✓
Type of Identification )
Produced '7ced 01Y• / tC•
(Signature otyota-ry Public- State of Florida )
Commission N I:arcod eunal
MY COMMISSION p GG 300817
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Physical Presence or _ Online Notarization
this _ day of .2020 by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
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