HomeMy WebLinkAboutBuilding Permit'I APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:%G C'%ranGl"
PROPOSED IMPROVEMENT LOCATION:
Address: I Li C P&
Residential
Property Tax I D #: r3 Ll l Q - S- I S - a Da(p 0 0 Z Lot No.
Site Plan Name:
Block No.
Project Name: T
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
t
Mechanical _ Gas Tank _ Gas Piping Shutters
Electric _ Plumbing _Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ IS74?00 , 0o
OWNER/LESSEE:
_ Generator
Sq. Ft. of First Floor:
Windows/Doors Pond
Roof Pitch
Utilities: Sewer _ Septic Building Height:
Namet.,(`lC����
Address: 1 L-1 n Ea m i' e Lane ..
city: Lac r-e- State: EL
Zip Code: 3 q Q 5-1 Fax:
Phone No. '? r, et q to G q
E_Mail:_lnecktes®be1)saci-Ah ne-4 _•
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name:
Company
Address:," O l I\-AnL I Is-( L )
City: Um State-fL
Zip CodeS-�, _ Fax:
Phone No --T1•k-4 - LJG-)
E-Mai
State o
unty License
el Q(0q0o-
ifvavalue 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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip:.
Phone:
MORTGAGE COMPANY:
Name:_
i Address:
Not Applicable
City: State:
Zip: Phone:
Not Applicable BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
l 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 Assoclation 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, scree; rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Recard a 'v'atke of Commencement may result in paying twice for
improvements to your property. A of Commencement must be recorded in the public records of St.
Lucie County and posted on the iobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording your Notice of Commencement.
ignature of Owner/ LessgQC66tractor as Agent for Owner
i nature of Contractor/UrdimerAolder
STATE OF FL RIDA
STATE OF FLORIDA
COUNTY OF ri
COUNTY OF
S or to (or affirmed) and subscribed before me of
hvsical Presence or Online Notarization
Swor to (or affirmed) and subscribed before me of
physical Pres nce or Online Notarization
thi ay of (_� It �� , 2020 by
this lay of � 2020 by
C.
Name of person malting statement.
Name of person making statement.
Personally Known _�_L OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identific n
Prod d
Prod c
(Si nature of No_ta ic- State of Florida)
(S' nature of Notary Public- State of Florida )
Commission No. � r. ( � Public State of Florida C mission No. C�1��-� �o"nDic state of Florida
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Kevin D Coo
My Commission GG 349462
Keook
' My Commission GG 34W2
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