HomeMy WebLinkAboutbuilding permitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
sue;
° 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: 10g1 i ) Wz-ftaAa W&V JZASe n §VeU C
Property Tax ID #: 45 0 q i�-o 2- _b a I -p o DO Lot No.
Site Plan Name:
Block No.
Project Name: 1iW8P
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 _Generator 4Z910of Pitch
Total Sq. Ft of Construction: JS60 Sq. Ft. of First Floor: !SOD
fj-
Cost of Construction: $ 7/ J-6d,1 _ Utilities: _ Sewer _ Septic Building Height: I t i
Na
Address. g Y q� I 'VV a' 1fl' 4 � k4 L
City: "' F� r` e /� Stat(: _
Zip Code: 3 YID Fax:
Phone No. -7 -7Z - 9'7--
a
E-Mail: 5ar. ir AJ $-ola1
Fill in fee simple Title Holder o1i next page ( if different
from the Owner listed above)
Name: Jf 4b- FIRFFdra_vg
Company: To 1-0,1
City: i'?3 k— + State: FL --
Zip Code 411 ry7 Fax: "7 7Z `r4%
Phone No ¢1 '� ^ ` . -:1Z/ 00350
E-Mail 56p.,'rhlTf�'��� ����d��, 0-64 or County License Ur-1'�3J�
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.
F
DESIGNER/ENGINEER:
Not 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 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 con lict 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 attorDrey before commencing work or recording your Notice of Commencement.
Sign atu of Owner/ Lessee/Contractor Agent for Owner
Signature of ContractdfjUcefise Hojder -�
STATE OF FLORIq� � —,
STATE OF FLORI �`-
`CCfJNTYOF (CaY
COUNTY OF��
Swear o (or affirmed) and subscribed before me of
Swor. Ito (or affirmed) and subscribed before me of
Physical Presence Online Notarization
Physical Presence or _ Online Notarization
"day
X, or
-
e-d ?a of L ' 4 "0 2020 by
this day of 2020 by
6;
55 t
fafne of person making statement.
Name of person making statement.
-orallyKnownOR Produced Identification
Personally Known '� OR Produced Identification
ofIdentification
Jye
Type of Identification/uced
,.
Produced_
(Signatu�Pyr Ib ii" State of Florida)
(Signatu f4rotary Public ate �PFlorida )
Commission No. (T (Seal)
Commission No.61"Or917318' (Seal)
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FRONT
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SUPERVISOR
PLANS
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REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Rev. S/b/ZU