HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICAB E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: i Permit Number:
44o �ILMCRE s
0
wV tL" Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578'
PERMIT APPLICATION FOR:
PROPOSED (MPROUEMENTLOC•ATION:
Address: a (-n
Property Tax ID q:
Site Plan Name:
Project Name:_
New Electrical Meter Second Electrical Meter
Lot No.
Block No.
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: $ (0,000 Utilities: _Sewer _Septic Building Height:
0W,NERYWESSEE
reONTRACTOR:
Name
Name. ==a "Yqe --!Sm�((
Address: U-.,I . —e-ogi lqVe-,
Company: `S L
City: State, Fcr .
Zi Code: Fax: a p
Phone No. :25-40- a%Sa
Address. 'BRy =, l'-� �
City: 5chEk--} ice) State:F
Zip Code:-32JEZ Fax:
Phone No 7-1a- 52-!I- I MSCK)
E-Mail: u� �J jars - -1 1 ramgj J.rom
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
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.
MORTGAGE COMPANY: _ Not Applicable
Name:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
UwlvtK/ SUN I KAL I UK Ahl•IUVI I: 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,Aconsult
with lender or an attornev before commencing wvork'nr recording vour Notfrp of CnmmPnramant_
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF C ��
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subs ihed before me of
__ Physical Presenceor Online Notarization
Physical Presence or Online Notarization
this,4 day of 2020 by
this _ day of 2020 by
t_kK ax-'�s
Name of person ma. i statement.
Name of person maki statement.
Personally Known OR Produced Identification ✓/
Personally Known OR Produced Identification
Type of Identificatior✓L
Type of Identific on
Produced 11� Q
Produced
(Signature of Notary Publi - State of
(Signatur of Notary Pbblic- State of Florida )
Commission No.
."""" ELLEN V
� ,State of Florida-
Lf(,L{ No. (Seal)
o y ub�lo
Ctommission #
G 2 079
Ontober 3
R, 22
REVIEWS
FRONT
ZO
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VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETE D
Kev. 516120 1 -Y.