HomeMy WebLinkAboutBuildiing Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:i Permit Number:
9�- �arC C
1 Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34952
Phone: (772) 462-1553 Fax; (772) 462-1578
PERMIT APPLICATION FOR: alwyl ��—
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ICJ #: SDI • i C�� • 0
Site Plan Name:
Project Name:
Lot No.
Block No.
E DETAILED DESCRIPTION OF WORK: I
RML� > tx: �A-00 �- lYTIr'x.;e or- >' r2x rrW-A,6 r4vi- �, c; e ► U ice► c
e:lc� _nA cct &,% ci -k7 co-dt . ppjA k rr-pdju- x_ u;7 ' a gmen-f v co—OtE7
New Electrical Meter Second Electrical Meter �"`�r Ne_ e-f VV*`
I, CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-- check all that apply:
,Mechanical _ Gas Tank —Gas Piping
— Electric _ Plumbing Sprinklers
Total Sq. Ft of Construction: ! 2-U
er)Q
Shutters Windows/Doors i Pond
_ Generator Roof Pitch
Sq. Ft. of First Floor.,
Cost of Construction: $ l—'-L+UC] . Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 5�1-1
Name: r �p
Address: il..ti„bar C+
City: I aVgb , T— State:
Zip Code: 2�01 05 Fax: � 1 A-
Phone No- i---�41'6-Lrl 10
Company: IcvtA G T
Address: 1 � S LY—
City: 06'74 -S - t t E.0 State: i�
Zip Code: ` q�5 Fax:
Phone No C� �
E-Mail:
Fill in fee simple Title Folder on next pager if different
from the Owner listed above)
E-Mail OrC rSfle : ['�'Oryl
State or County License rCC, I
F! Vdlur Qr wnsrrumon is a,uu or more, a KLILUKUtU Notice of commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTIR UCTI0N LIEN LAW INFORMATION:
DES[GNEIi�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:
I
OWNER CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to d❑ 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 1n 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 Cou ntya nd posted th ' bsite before the first inspection. If you intend to obtain financing, consult
with lend n attar re commencer work or recording our Notice of Commencement.
Sign Owne essee/Contractor as Agent for Owner
&Signature of�rfra or/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
Sworn to (or affirmed) and subs ribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Pres nce or Online Notarization
i. Physical Presence or Online Notarization
this -'5` day of UJ 2020 by
this2t[day of JuL1 2020 by
Name of Orson making statement.
Name of person making statement.
Personally Known i OR Produced Identification
Personally known VstOR Produced Identification
Type of Identification
Type of Identification
Pr _ d —
Produced
(Signature of Notary Pu c- 5tat ridi
ature of Notary P b '
ssy-a
=,'d
of FI
No.
y rruwm� GG 985470Commission
` om 'fission No. 0"@"4
L;"
+�G 9b
4
70
REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED