HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLIC�A•IB E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ! -1 r)-() a--O Permit Number:
J F �QOE
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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:
Property Tax ID #:
Site Plan Name: _
Project Name:
00d3 —060
DETAILED DESCRIPTION OF WORK: '
New Electrical Meter Second Electrical Meter
I CONSTRUCTION INFORMATION:
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: 1 90 0
Cost of Construction: $ � 40 0.OD
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
00,U e2S
Name
17/ qix fn
Address: O vns D(
Company:
City. �. I ,LIC %? State:
Zip Code: Fax:
Phone No. %fir}-370 ' 3to9
Address:
City:
Zip Code:
Phone No
U
3
E-Mail: D S0 Yll
Fill in fee simple Title golder on next page (if different
from the Owner listed above)
E-Mail
State or C
unty 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.
I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: I
DESIGNER/ENGINEER: _Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name: (� -eV1. SlCw
Address: . D I
City: ysLStat
Zip: V 35 Phone: 3/n— /Vad;>—
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
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
utirh landar nr an attnrnpv hpfnrp rnmmpncine work or recordine vour Notice of Commencement.
Signature of ner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA /I,,
STATE OF FLORIDA
COUNTY OF �t-UA-
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
_ Ph sisal Prese c or Online Notarization
Physical Presence or Online Notarization
this,W day o 2020 bo
this _ day of 2020 by
Name of person making staternkfit.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
ype of Identification
Type of Identification
oduceA
Wna
Produced
of Notary
(Signature of Notary Public- State of Florida )
.'�"?4`�'•• LASHAHWINGRAM-RAHMING
Commission No.
'- My G%3M80I0N 9 GG 275080
Commission No. (Seal)
cP; EXPIRES: December20,2022
eFor•.e.,
eo�ec
REVIEWS
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ZONING
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MANGROVE
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DATE
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COMPLETED
Rev.5/6/ZD