HomeMy WebLinkAboutBuiding permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
L.�?L
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: (7721462-1578
PERMIT APPLICATION FOR:
�IC [han ec��F
PROPOSED IMPROVEMENT LOCATION:
Address: S C� Z r- &ak L,
k
Property Tax I D l#:. C3 Lot No._
Site Plan Name: Block No.
Project Name:
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New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit — check all that apply:
Mechanical
Electric
Gas Tank
— Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ AEG 0 o y U O
OWNERAESSEE:
Gas Piping
Sprinklers
Name '
Address: )
City: r 4 t' '�V-State:
Zip Cade: ? 4 Ct Z Fax:
Phone No. 77 Z Ct 7 I cl
E-Mail:
Shutters _ Windows/Doors Pond
Generator ` Roof Pitch
Sq. Ft. of First Floor:
Utilities: `Sewer —Septic Building Height:
CONTRACTOR:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:-C-M�JC
Address:
City: (-t State:
Zip Code Fax:
Phone Nl �`� "�t� a)
E-Mails LDS�- [
State o County License . 1, }
If value of construction is 2SOO 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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 su bject structu re
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, wa[Is, 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.
nasture of Owner/ Lesse ractor as Agent for Owner Sighature of Contractor cense Holder
STATE OF FLORIDA STATE OF FLQRIDA
COUNTY OF (—'� COUNTY OF-1i
Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
hysical Presence or Online Notarizationsica! Pres nce or Online Notarization
this r day of. ]S '� .2020 by tht -i cs of ,v T-[ 2020 by
3
ame of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of dentif[cation Type of Id ' tif[c
Prod d Produce
i
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: .€_� LA � Mot Commission N GcStateofFiorida
Commission NaC� { �
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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