HomeMy WebLinkAboutBuilding Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -C9Permit Number:
0.
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial
PERMIT APPLICATION FOR: E�e-CA, -:` c
PROPOSED IMPROVEMENT LOCATION:
Residential
Address: i 'n !r(11 (4� t 0 ;` 'C,:� 1A V L 'S cjgl5'2-
Property Tax ID #: _i Lot No.
Site Plan Name:151 u - i�ly �t�C�v'lj- Block No.
Project Name: �) 1cAS\0Lt
DETAILED DESCRIPTION OF WORK:
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 _ Windows/Doors _ Pond
X Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ I?, 0 ( 0
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: NQC -7�-
Address: � i� �tYl�r� (3 �1� �`� b
Company: E-6k' Fte -+-(1C a0 (-A (4
City:®C� P State:l �
Zip Code:_ Fax:
_
Phone No. 9, L-/ - 66 �-�10JR-
Address: tA� �,,i 18�\If
Cit Y: �(�� � � r�J1C.t �- State: F
l" �
Zip Code: S3 qq&L! Fax-74.1-3qQ ,3K)J
Phone No 730 `�3LJO- i374-q-4-
E-Mail
E-Mail: ',C_W 3L150'CA Y`1'4 k 1. roirn
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License EC tz00 (Q()?1("
--- -- ---- —• ••• — .. VI b.V IIIIIICIIGCIIICfII IS requires.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRU TtON LIEN LAW INFORMATION:
DESIGNER/ENGINEER: / _ t Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: Not Applicable
Name:
BONDING COMPANY: IX 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 recordine vour Notice of CnmmPnrPrr,Pnt
Signature o wner/ Lessee/Contractor as Agent for Owner
Signature of Con actor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Sr L.Uc n'
COUNTY OF Sf t,U c r
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
X Physical Presence or Online Notarization
_ Physical Presence or Online Notarization
this �"day of _ ;1 2020 by
this-33'0 day of � '\ 2020 by
JOt-f-rN P4mc 214. L
Name of person making statement.
Name of person making statement.
Personally Known X OR Produced Identification
Personally Known X OR Produced Identification
Type of Identification
Type of Identification
Pro
Produced dNl LENAE DEWI?T
lvNI LENAE DEN FT
Notary NoPublic State of Florida
__ _ Notary Public — State of Florida
e + ,, 15
/� � a Commission It GG 166.,o
C m r sion 41166915
; ,,+,III i7�, • Ex fires Doc 10, 2021
Si nature of Notary Pu lii � '" ``ofIFF6i+M pares Dec 10, 2021
( g ry
o c , National Notary Assn.
(Signature Notary Pu is-''tt1 bf �l�t �It ry
;.
Bonded Through Nafiona! Notary Assn.
Commission No. G t Seal
Commission No. CGtb��+rS (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.