HomeMy WebLinkAboutBuilding Permit All APPLICABLE INFO'MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 20 7
s
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
PERMIT APPLICATION FOR: i,
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID•#: Lot No.
Site Plan Name: AIIA04 112 r(101314Q1 8 Block No.
Project Name:
Du-AILE•D.DESCRIPTION,OF WORK: (� "
r
New Electrical 4pter Second Electrical Meter
CONSTRUCTION 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:$ Y e oo. e Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name: J.t?L]" &CG15
Address: 1-3 Iq 9zez k„C,L be" Company:
City:_ �7-S j to c P- -State-r: Address: z0 - 5. �LC�/F�-P
Zip Code: :34(-@.s"Z Fax: City:__ r7'C State•
Phone No. 2C2 If 42 S.-O Q.TZ- - Zip Code:�� R��i Fax:
E-Mail: Phone No 7 " 2�J��3'q-(
Fill in fee simple Title Holder on next page{if different E-Mail r�oLL/,_S (.7 Beet,` ;UQ-jV D A/L!
from the Owner listed above) State or County License .
If value of construction is 2500 or more,a.RECORDED Notice of Commencemdnt 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 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 thepermit 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 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,wails,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencementmay 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 attorneV before commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Uent for Owner SigKafure of Contractor/License Hold&
STATE OF FLO19PA STATE OF FLORIDA
COUNTY OF - LGu_e_ COUNTY OF1- C�
Swoyn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
V P ical Presence or Online Not rization P ical Presence or Online anzation
this day of 20 Notarization
this day of 20� by
ca CU
Name of person making statement. —:2 N Name of person making statement. o,� o
o�m ¢ A9
Personally Known OR Produced Identi8 tt t� Personally Known OR Produced Identificat [V iR-
'Type of Identification mi M Type of Identifi 'on �co o.
Produced Produced _ m
�G EE O2, E
~ � _�-o E .'1 M o U
-(Signa re 6f Notary Public-State of Florida) z 4 (Signat a of otary Public-State of Florida)
ffi�nn nn0 `� J0�
Commission No." (22't9 Ic (Seal) QJ0° Commission No. 69 -1 9 (Seal)
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REVIEWS FRONT ZONING PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Etv.5/6/20
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