HomeMy WebLinkAboutBuilidng Permit All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: �� �07—p Y
OUNTY
,_. .. . .�W.� � Building Permit Application pepart"�e�'
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Planning and Development Services St.�u
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: 3L�
Property Tax l D#: U C7 � —C�O® "/� Lot No.
Site Plan Name: Block No.
Project Name:
QETAII.ED DESRlPyTION OF WORK
New electrical Meter Second Electrical Meter
CQ< CSTRl1CTI Qlt INFORMATIQN` '.
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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 61 oof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ roa Utilities: —Sewer —Septic Building Height:
C�VIINERjLESSEE CONTRACTQR
3
Name 4 _ Name:
Address: �� � ✓ vim, ' :, :Company: A1,LZ v'
City:. State:��/a Address: n � _
Zip:Code� ? C�d Fax: City:' if s� State:��
Phone No.
'��% G) Zip Code: / r Fax:
E-Mail: Phone,.No
Fill'in fee simple Title Holder on next page if different E-Mail 12
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.
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CIESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: —Not Applicable " BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
-Zip: Phone: Zip: Phone:
OINNER/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 ol-an_attorney before commencing work or recordin vour Notice of Commencement.
1-41)
Signature w Lessee/Contractor as Agent for Owner Signature of Con r or/License Holder .
STATE OF F RIDA STATE OF F RIDA
COUNTY O tL1 Lo 1w" �'� COUNTY O
Sworn to(or affirmed)and subscribed before me of Swor to(or affirmed)and subscribed before me of
��hysical Presence or Online No arization "Physical Presence or Online Notarization
this day of 20 IAy this day of 20 �by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Q,� Personally Known OR Produced Identification
Type of Identification Type of Identification`
Produced oduced
U U
a: ON 0 "610 - l 7 N m
(Signature of Notary Public- ate of Florida ). ,L - x ignature of Notary Public-State lorida) O ?� aN
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O C O C
Commission No. (Seal) m ZCD y mmission No. (Ser -2
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ID
REVIEWS FRONT ZONING SUPE 1 0 U_ LANS VEGETATION SEATURTLE E
COUNTER REVIEW RE VIEW REVIEW REVIEW = �E
:DATE
RECEIVED
DATE
I-OMPLETED
E?V.5/6/20