HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFOMUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: q 1 _ Permit Number:
R
`'' 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:
PROPOSED IMPROVEMENT LOCATION:
Address: , �i � , L
�7
Property Tax ID #: 130 1 — Utz —66 j/ " I Lot No.
Site Plan Name: I c_ Block No.
Project Name:JJ
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DETAILED DESCRIPTrt�N OF.INORK.
I �� 'i �ir��'� �.
MC
New Electrical Meter 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 t 1?-Pitch
Total Sq. Ft of Construction: p- CC Sq. Ft. of First Floor: 5
Cost of Construction: $ �"� U Utilities: —Sewer _Septic Building Height:_
OWNERAESSEE:
CONTRACTOR: ' �o
Name (6W 4 gay
Name: I1 ,3
Address: _ 0
Company: C}
City: Tr Pi - State:
Address:
Zip Code: Fax:
City: — F i r"ru State: Fc—
Phone No. 774— L f 1— /110
Zip Code: Fax:
Phone No_SOS'C
E-Mail: 1'4�i VL4VrY 1 7� �—
E-Mail
Fill in fee simple Title Holder on next page ( if different
State or County License
from the Owner listed above)
1
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.
';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
Name:
BONDING COMPANY: Not Applicable
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 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 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.
ignature of Ow er essee/ tr ctor as Agent for Owner
Sign ture of Con ractor Lice se HoI er
STATE OF FLORIDA
COUNTY OF
STATE OF FLORIDA
COUNTY OF ��
S rn to (or affirmed) and subscribed before me of
Ph sical Pres nce or Online Notarization
this �° day of ( L 2020 by
�n to (or affirmed) and subscribed before me of
Physical Presen or Online Notarization
this day of (� 2020 by
j < +LJ
ame of person akit s temeo .
Nam person making s tement.
Personally Known OR Produced Identification
Type of Identification
Produced
Personally Known OR Produced Identification
Type of Identification
Produced
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(Sig otary u lic tie o., orioa"
e; r�- Nip I f MMISSION #GG165030
Commission No. 9� _ \P+gES: DEC 04 2021
R. 8046 Yough 1st State Insurance
-"
(� of otary Public- Staile� nda ) KATHERINE HAVENS
DIY COMMISSION #aG16503
Commission No. ,4 P= (SIRES: DEC 04, 2021
°FRS Bonded through 1stState !psurar,
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