HomeMy WebLinkAboutBuilding permit applicationAll APPLICABLE
Date: - �/ LA
NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Permit Number:
Building Permit Application
Planning and Development Services
Building and Cade Regulation Division
2300 Virginia Avenue, Fart Pierce FL 34982
Phone. (772) 462-1553 Fax-, (772) 462-1578
Commercial Residential '1�
PERMIT APPLICATION FOR
PROPCi�ED IMPROVEMENT LOCATION;
Address-, ni i-A 4� r
Property Tax ID #: L'1 rJ i \ " �� a ' CJ � 2. ;� C)c;� Lot No.
Site Plan Name:
Project Name:
New Electrical Miter
Second Electrical Miter
:. if ri�.vvii: '•
h %"STR':U'C%'T--.,!-O%'N-,-I,NFOR-
... ..........
Additional work to
be performed under
this permit - check
all that apply:
_Mechanical
� Gas Tank
� Gas Piping
-Shutters
Electric
Plumbing
Total Sq. Ft of Construction:
Cost of Construction:
City:
State:
Zip Code: �-4 ri � 'Fax:
Phone Na. 2, 2-d-� - 14 q
E-Ma i
Generator
q, Ft. of First Floor:
Black No.
Windows/Doors Pond
Roof Pitch
UtI iiti: Sewer Septic Building Height:
Fill in
fee
Simple
Title Holder on next page ( if different
from
the
Owner
listed above)
Address:
City: QC- 0 0.b4. State:��
Zip CodeFax:
Phone No-
E-Mail
State or County License
1f
value
of construction is
2500 or more,, a RECORDED Notice of Commencement is required.
If
value
of HAVC i 7.,500
or more., a RECORDED notice of Commencement is required.
IlaI I M.
Address: _
City: State:
Zi : Phone
FEE SIMPLE TITLE HOLDER:
Name.1h
Address:
city...
Zip: Phone:
_Not Applicable
Name-
AddressL
City: State:
Zi } Phone:
BONDING comPANY: Not Applicable
Name:
Address:
City:
Zip:
Phone:
1N E R/ CONTRACTOR AF F1 [VIT� � i atir� � I-��r� � r�a� ... — .._
p e to obtai n a p r rt to the work and -1n talIatlan as indicated.
I certify th at no workor i n tal l at ion h as corn lT e n ced prior to the rssu a n ce of a perm it.
t. Lucie County makes no representation that is granting a � rm it will authorize the permit holder to build the subject structurehih iin coIi�t with any Hone Owners Association rules, bylaws or and covenants that r restrict or prohibit
structure. Pleaseconsult with our Hoy Owners � such
Association and review your deed for any restrictions which may apply -
in onsid erati ors of the granting of this requested permit{ I do hereby agree that I will i n all respects,espects, perform the work
in accorda rice with the approved plans* the Florida BuildFi rig Codes and St. Lucie Cou nty Am endment .
The following buldin permit applications are exempt frormundergoing a full concurrency F.- ie r-
. room additions,
accessory structuresp swimming pools, fences., walls, signs, screen rooms and accessory uses to another non-residential use
WARNING 10 OWNER: Your failure to Record a Nntiro of C"nmrttnnrnrriIF I ..-. ...r......... �.......,. �_.�
-�-•..�- ■+■ �11I110]I 1C,7{,11L 111 Flclyli16 CW1L,d IUf
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and pasted on the Jobsite before the first inspection. If you intend to obtain financing, consult
with lender or are attorney before commencin work or recordin Qur Notice of Commencement_
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLOWA
COUNTY OF
&worn.�to (or affirmed) and subscribed before me of
Physical Presence or Online Notarizaiion
this day of ,t , 2020 by
<J
Name of rr making statement. i
Personally o�n OR Produced Identification
Type of Identification
Produced
op JN
(Signature of Natar ic- St �
Commission No.
Signature of Contract
STATE OF FLOR
COUNTY OF
/License Holder
Sworn to (or affirmed) and subscribed before me of
Physical Presence r Online Notarization
this' -day ofr}' 2020 hy
S
Marne of perms making statement.
r
rr- rU Hal I nn . .
Type of Identification
Produced
i n
Nata-Fy Public - State of Flori e
GG 308C�bnir
Of .my Comm. Expires mar 5 r 2023
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COUNTER REVICW REVIEW REVIEW REVIEW REVIEW REVfEW
DATE
RECEIVED �
DATE --
COMPLETED
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