HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: / PermitNumber. V l
L 16 2020
LSTLujdie
Building Permit Applicatio County, Permitting
Planning and Development5ervices
Building and code Regulation Division ComrneFCial Residential.
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: ��1D he Ir s
Property Tax ID #: G Lot No.
Site Plan Name: Block No.
Project Name: S , A 1b
'. 101
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R K:a �L��-S- a te)
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New electrical Meter Second Electrical Meter
INN
WIN USA— WHOIN x _INI
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Additional work to be underthis permit— check all that apply:
;perfo -
Mechanical Gas Tank Gas Piping — Windows/Doors Pond
_Shutters
1Z Electric —Plumbing _Sprinklers �[ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: _Sewer _Septic Building Height:
a� . ih6 -N)OW
Name:
Company'." ,;...,. .
%'ddress:
City: o State: V'
Address:
City: State:_
Zip Code: —=L=�,�Z Fax:-
Phone No. %j% a f (A— ! (p9
Zip Code: Fax:
E-Mail:_k
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail
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.
s
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: — Not Appligble , .
Name: Name:
Address: Address: State: -
City: State: City:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER:. _ Not Applicable
Name:
Address. -
Zip: Phone:
Address:
zip: Phone:
Applicable
OWNER CONTRACTOR AFFIDVIT: permit to is hereby made to obtain a perto do the work and installation as indirated.
I certify that no work or installation has commenced prior to the issuance. of a permit
St. Lucie Counttyy makes no representation that is granting a permit will authorize the permit holderto 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 consultwnh.your Home Owners Association and review your deed for any restrictlons which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the woek
in accordance with the approved plans, the Florida Building Lodes 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: Ifyou intend to obtain financing, consult
with lender or an attorney before commencing work or recording your Notice of Commencement. - r
Signature of weer/ L e/Cant or as nt r Owner
STATE OF FLORIDA.
COUNTY OF
Swom to (or affirmed) and subscribed before me of
Physical Presence or_Online Notarization
this—C d"ayof MJ\T-203�Aby
�CN\ktlC -
Name of person making statement
Signature of Contractor/License Holder .
STATE OF FLORIDA
COUNTY OF
Swom to (or affirmed) and subscribed before me of
Physical Presence or _ Online Notarization
this _ day of 20_ by
Name of person making statement.
Personally Known OR Produced Identification I Personally Known OR Produced Identification
Type of Identification Type of Identification ,
Produced IF V0 L. Produced
(Signature of Notary (Signature of Notary Public -State of Florida )
- !,".rw••,C,'^�y`•ti DEANNAMARIE GIVENS i;
Commission No. SSION9GG 022023 ( Commission No. _(Seal)
E>Detember16,2020 ,,
SandedTlw Notarr'PuNk UndanvAter. 1.
REVIEWS I COUNTER I REVIEW I SREVIEW R I REVIEW I VREVIEWON �SREVI}EW E II REVIEW