HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: la oao Permit Number:
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Building Permit Application
Planning and Development Services coo o4d Oj®
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:
IMP bv,,EMENT "LOCATION
Address: L/ Z K(4 /)1 16 G Aj
-r (_ t4
Property Tax ID#: -341 %- IDS'- OCR���- C-:)on - 3 Lot No. 2�a
Site Plan Name: Block No. �Z
Project Name:
DE�1'AILED DESCRIPTION OF V1/ORK
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20 r`,.�... ��a2 6) -77l
W4a'Oc 1-
New Electrical Meter Second Electrical Meter
k_CONS�TRUCTION INFORMATION
Additional work to be performed under this permit— check all that apply: /
Mechanical Gas Tank Gas Piping —Shutters \/ Window /Doors
— Electric — Plumbing — Sprinklers — Generator _ Roof
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor:
_ Pond
Utilities: —Sewer —Septic Building Height:
Pitch
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�®WNER/LESSEE#�°rii
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"CON7 RACT(OR
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Name L 7 Y
Name:
Address: (c/Z �i9 j�Yl t 1= Z.,L)
Company:
City: &T s'4,,A! 7- t m C, ,�_z State: E�_
Address:
Zip Code: g.S"Z. Fax:
City: State:
Phone No.
Zip Code: Fax:
E-Mail: OL ;.�n44 72 & e02?AZZ_ a C6P1
Phone No
Fill in fee simple Title Holder -on next page ( if different
E-Mail
from the Owner fisted above)
State or County License
IT value or construction is Z500 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.
S'URREEM �AUCOtNSTRUCTI,QN LhEN LAVV INFORMATION
DESIGNER/ENGINEER: _
Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
Name: A/' cW 2F
o2 o c= Q _
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 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.
1 Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
1 with lender opan attorney before commencing work or recording your Notice of Commencement.
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Signature of wner/ Lessee/Contra or as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORID
STATE OF FLORIDA-
COUNTY OF r ck �,
COUNTY OF
Swo to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Presence or Online Notarization
this Za day of (.l 2020 by
this day of 2020 by
i
Name of per on making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
( ignature of Notary P
(Signature of Notary Public- State of Florida )
Notary Public State of Florlde
*,40&N
Commission No. victori qQ atnouse
MyCom4tI GG243sa0
Commission No. (Seal)
`Expires 07/31l2022
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