HomeMy WebLinkAboutBuilding permit ApplicationAll APPLICABLE INFO MUST' BE. COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: z'Permit Number: o 7 4 972
JUL1 1 2020
permitting,nt
a county
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:
Address: - i) Z 0-ibo C L - c_ �`y �n ct Z WIL Cf
:�j
Property Tax ID #: Q j aa � 6 ®7 Lot No.
Site Plan Name: -.Block No.'
Project Name:c l/V "-D
C i u-(_ S
New electrical Meter Second Electrical Meter
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: Sq. Ft. of First Floor:
Cost of Construction: Utilities: _Sewer _Septic Building Height:
x
I
Name Z3 C �j ,fi�r '� 1� aL9 e 6 c re
Name:
Company:
0
Address: 0� ,5 KI -06,001C
City: Q X C Stated -
Address:
City: State:
Zip Code: Fax:
Phone NoQ '77 Z- 3 � 1-zoo 93
Zip iCode , _ ---Fax:
' E-Mail: IA--
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.
DESIGNER/ENGINEER: �ot Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State
Zip: Phone Zip: -- Phone:
FEE SIMPLE TITLE HOLDER:. — Not Applicable BONDING COMPANY: Not Applicable
Name: 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 permii
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 consultwith.your Home Owners Association and reviewyoue 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 andaccessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice pf Commencement may re! .iri_ paying twice for
ithptdVements 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 of - n attorney before commencing work or recording your Notice of Commencement.
as Agent for Owner . I Signature of Contractor/License Holder .
STATE OF FLORIDA. STATE OF FLORIDA .
C.OUNTY'OF"COUNTY OF_
swom to (or affirmed) and subscribed befor me of
Physical Presence or Online No 'zation.
this _day of (� J'i , 20_ by
C+ rG
Name of person making statement.
Personally Known OR Produced Identification
Type of Ide itificatior �
Produced
Rk 1CW --
(Signature of Notary Public -Mate of Florida )
Commission No. .` AEY111 a1, (S&1 EN VA U G H N
;State of Florida -Notary Pub
y Commission # GG 27007
REVIEWS FRONT _zVMN
COUNTER REVIEW REVIEW
DATE
RECEIVED
xih&
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of , 20_ by
Name of person making statement.
. . 'Aill
Personally Known OR Produced Identification
Type of identification
Produced
(Signature of Notary Public- State of Florida )
gission No. _(Seal)
,NS VEGETATION SEA TURTLE
EW REVIEW REVIEW
MANGROVE
'REVIEW