HomeMy WebLinkAboutBuilding Permit Application IAII APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED "
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Date:' Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial' Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578
PERMITAPPLICATION FOR:
PROPOSED IMPxR'OVEMENT LOCATIQN: 011
Address: 2 I Keen P_A
Property Tax I D#: I q-31`0 Z V Ol 2 O 0(9 Lot No.
Site Plan Name: Block.No.
Project Name:
8'
DETAILEUDESCRIPTION`OF. WORK.
_U9141( !o 92.0 She-d 41 6'_ Corny o-F Prone-
---- -
New Electrical Meter Second Electrical Meter
CONS,TRUCTIQN-INFORMATION = :
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 —Roof " Pitch
Total Sq. Ft'of Construction: - Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: —Sewer _Septic Building Height:
01NNER/LESS&E `" CONTRACTO'R:° _
Name. J6'h&( .4= Name /: .
Address: 2llo Kee„ Ccim'pany: /,, e SW8• .$'k1O10
City: For-F- P t&te State: Address: &-yo
Zip Code: Fax: City: 1004: U did E State: or—i—
Phone No. 77? -ITC/0 Zip Code: 3 cf Q$q Fax:
E-Mail: JS'�eyen5 Z�t� A��lr7oli I. Co k Phone No 772-q�9,_ KO qc)
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: -
SUPRLEMENTALfCONSTRUCTION LIE'N.LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: 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 l will,in all respects,peff&m 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 recording our Notice of Commencement.
SiErture of Owner/Le see/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF a. COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Prese a or Online Notarization Physical Presence or Online Notarization
this day of 2020 by this day of 2020 by
Nam of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Pr duced Produced
3
( g ature of Notary PTleR p INGRAIN-RAHMING (Signature of Notary Public-State of Florida
MY COMMISSION#GG 276060Commission No. �(pllf�?decennber20,2022 Commission No. (Seal)
onded Thru Notary Public Underwriters ,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW.. REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 5/6/20
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