HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MusT BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
.:. , Oil,:Building Permit Application
Planning and Development Services
Building and Code Regulot:on DMsiors Commercial Residential _
2300 Virginia Avenue; Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 452-1578
PERMIT APPLICATION FOR: � �--� T nSic.d.... 'an �
PROPt)SED IMPROVEMENT LOCATION:
Address: Ur.
'_
Property Tax ID 9: _ � J _ �Q__ T
Lot No.
Site Plan Name:
Block No.
Project Name: ___
-- --
DETAILED DESCRIPTION OF WORK:
i
l
�tj
i 1
New Electrical Meter Second Electrical Meter `
CONSTRUCTION INFORMATION: �
T
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 C+instruction: $ — Utilities: --Sewer --Septic Building Haight:
OWNFRAESSEE:
CONTRACTOR:
Name l I 1 _-IQCCMC
Name:
Address: '�If y— .
Company:
Address:
�.
City: r—is _ State; L
Zip Code: Fax:
City:
State:
Phone No, � �
Zip Code:Fax13 :
E -Mail
Nt�
Fill in fee simple Title Halder on next page (if different
E -Mail
State or County License_ � N
,^ —
from the Owner listed above)
if value of construction is 2500 or more, a RECORDED Notice ,of Commencement is required.
J value of HAVC is $7,500 or more, a RECORDED Notice sof Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: — Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: _ State:
Zip: — Phone_ _ —
City: State:
Zip: Phone:_
FEE SIMPLE TITLE HOLDER: — Not Applicable—
Name:
BONDING COMPANY: ,Not Applicable
Name: _
Address:
Address:
City:
City:_ —
T _
Zip.. Phone: _
Zip: Phone: --
OWNER/ CONTRACTOR AFFIIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
certify that no work or instailation 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 pasted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording your Notice of Commencement.
cidAA
Signature of Owner/ Lessee/ContrAdor as Agent for OwnerSignature of Conti for/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Si Lac: — COUNTY OF 'Si . l "Ac �"e
Swo n to (or affirmed) and subscribed before me of
P slcal Presence or Online Notarization
this j day ofL:Lcj. —_, 2020 by
KG41<wQn V\"t-
Name of Gerson making statement,
Personally Known J OR Produced Identification
Type of Identification
Produc d
(Signature of Notary Public- State of Florida )
Commission No, G 6&Ze;.3
F
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
Sw o to (or affirmed) and subscribed before me of
�`ff Physical Presence or Online Notarization
this day of.__ JAU_ _ _, 202D by
V'C' -Vh
Name of per9on makingstaternent.
Personally Known OR. Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
{seal Commission No. C
v � 7f o't F s133
NGS' ,..,;54V PLANS VEGE,
EW'B. REVIEW REV
REVIEW