HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Numbe
a
LEE - Building Permit Applicati(
Planning and Development Services
Building and Code Regulation- Division Commercial Re
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION -FOR:
2
I
... Ib
Yu'`' 2 6 2020
Permit�,:'�ir.,� .,�'.:;_,��,r`:rnen
0effih _uC : o"u, nty, FL
Address: 136"M SOUTH -TNDiwN (�,ibojz K)K. `3641fN 0J2ACP FC,3795
Property Tax ID #: �o I �� d (� Lot No.
Site Plan Name: Block No.
Project Name: �o e/J e-X41-01K
New Electrical Meter Second Electrical
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank _Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric _ Plumbing _Sprinklers 1XLGenerator Roof Pitch
Total Sq. Ft of Construction: C� Sq. Ft. of First Floor:
Cost of Construction: $ f Utilities: -Sewer —'Septic Building Height:
OWNER/ r5SEE:
GONTRACTO
Name L)ce KNI&HT
Name:
Address: /3 S'f9 50yTo 77MI011411 rZl Ule 1 Of.
Company:.
City: �l'iJ.CQ�J Z4� N State: C-
Zip Code: � Fax:
Phone No. --`q%%,S-
Address:
�i
City: �� . iState:_
9.
Zip Code;' A"O, "' °' 'i Fax: .
Phone No
E-Mail: l` leuce d (M ed i,4Si?b. e lgsd Co WI
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 $7,500 or more, a,RECORDED Notice of Commencement is -required.
U L NTr t �O
DESIGNER/ENGINEER:
Name:
d
Not Applicable
F
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
(
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 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 attorney before commencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORID -
STATE OF FLORIDA
COUNTY OF �P�
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Pres nce or Online Notarization
Physical Presence or Online Notarization
this 1,2k day of 2020 by
this day of 2020 by
e j'A h
Name of person makin tement.
Name of person making statement.
Personally Known OR Produced Identification '�
Personally Known OR Produced Identification
Type of Ide t"fication
Type of Identification
Produced A r -
Produced
(Signature of Nota Public- State of Florid ) -
(Signature of Notary Public-. State of Florida )
Commission N
Commission No. (Seal)
•::w�eti"•: AUDREYsmumPHREY
`� •S
MY COMMISSION 8 GG 300817
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XPIRES: March 6,
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Rev.5/b/20