HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
91ro
3.
U U. 0 Da o Vk Building Permit Applicati�n�l
Planning and Development Services N' 2�p
Building and Code Regulation Division Commercial ReS p�l AI
2300 Virginia Avenue, Fort Pierce FL 34982 otood
Phone: (772) 462-1553 Fax: (772) 462-1578 �46711o0
PERMIT APPLICATION FOR:
I PROPOSED IMPROVEMENT LOCATION: 2151 1 A ba %/14hA ,Tv^I n.na- %n& r-i �It
Address:
Property Tax ID #:
Site Plan Name:
Project Name:Ol�
!7 \YGTCI�i�\C
Lot No.
Block No.
I DETAILED DESCRIPTION OF WORK: 1, , Ln II 7 n f 1-1_I GL ..11. r� I
New Electrical Meter Second Electrical Meter.
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all th�tapply:
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:
oe
Cost of Construction: $ � 2 3 310n . Utilities: _Sewer _Septic Building Height: 2j-44-
OWNE LESS •
CONTRACTOR:
Name
Name:
Address:
Company: n
, ,^
�r
City: L�1'a' 1 � ie, State:
Lurie,
Zip Code: c�l��'i Fax:
No. �Sle 11 (-3-1 D - q 4-1 q
Address: LALe 2, tJ VJ 'VSC-1—
1
City: MlaMokc State-.-EllPhone
Zip Code: Fax:
Phone No
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License. ZO
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
Name: 7
MORTGAGE COMPANY: _ otApplicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HO ER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: one:
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 vour Notice of Commencement.
Signature of Owner/ Lesse /Contractor as Agent Tor
Signature of Contractor/License Holder
STATE OF FLORIDA 6
STATE OF FLORIDA
COUNTY OF ti L-0 G f rS
COUNTY OF V n e-a.7,�j-fr D
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Ph
W Ph sical Presence or Online Notarization
by
io Physical Pretence or_ Online Notarization
day 23, 1 !
this of 2020
t is � of u. L . 2020 by
Name of person m Ing statement.
Name of person making statement.
Personally Known OR Produced Identification ,G'
Personally Known XI OR Produced Identification
Type of Identif lion
Type of I
Prqdne
Produce
(Signat
(Signature of
-
STEVEN E PUL IA
LLIAM
Commission
N0.': MV COMMISSION (�e§I)34124
Commission N:'=
MV COMMISSI134124
74"q
EXPIRES November 18,2021
EXPIRES November 18,2021
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COMPLETED
ev. 516120