HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
C0UNTY
Building. Permit Application
Planning ond'DevelopmentServlces
Building and Code Regulation Division Commercial Residential
2300 Vlrginla Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (712) 462-1578
•
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Property Tax ID'#: 3y/Y-,7L.50-yodvrb
Site Plan Name* Project Name:
DETAILED•.DESCRIPTION,OF WORK:
n . /,. , A n l . - . - - s A .rirYYl
t
New Electrical Meter Second Electrical Meter
_____ ---:—
Lot No. cll �z
Block No. Y—
I CONSTRUCTION INFORMATION: I
Additional work to be performed under this permit- check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
Electric Plumbing Sprinklers _Generator _Roof
Total.Sq. Ft cf Construction: 47e4xa6o� Sq. Ft. of First'Floor:
Cost of Construction:$ o20/42Ur7Utilities: _Sewer _Septic Building Height:
Pond
Pitch.
01NNER/LESSEE:
CONTRACTOR'
Name
Name:
Company:DOOM a .cf I�t ncFo
Address: M�/G�irtai- 1: e
City •D,o i ..{' 7°i�A1pJ Stater
Zip Code: 35/999 Fax:
Phone No.-?03 396 - 09!?y
Address:-4-V6.)JGy e�-&a• &Jft' ' ''A
City: Stater
Zip Code: : Fax:
Phone No
E-Mail:ToIjnlSdrilJ(ZAl A a e;MA11- • CoM
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail Q%
State or County License 0 BC IQ 6 al(;? 7
if value of Construction 6 75uu or more, a-itmunucu t%wL w — w........
.�•••..• •• •.. • -+-•• if value of HAVC Is $7,500 or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCTION LiEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: Not Applicable
Name: ^ 9E. Name:
Address:, 0/ IdW60410 Address:
City: Asx� State: M City: State:
zip:336o9 Phone$`/3 .$JyM3 Zip: Phone:
FEE SIMPLE TITLE HOLDER: X Not Applicable
Name: /`
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Applicable
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 cori ict 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 conwrrency 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 attornev before commencing work or recording your Notice of Commencement.
�Sig;rdtureq — / Lessee/Contractor as Agent for Owner
SignatUt _oT ntrattorr License Holder
STATE OF FLORIDA
OF LL1Ll�
STATE OF FLORIDA3,_
OF i I
/.(I �/L
COUNTY
COUNTY
(
Sworn to (or affirmed) and subscribed before me of
Swor o (or affirmed) and
subscribed before me of
1�Physical Presence or Online Notarization
this' day of �}� . 20�o by
hysical Prese ce
this day of
_ Online Notarization
2 by
kfw\ ��ahnscx�
H' 411
Name of person making statement.
Name of person making statement.
Y/
Personally Known V OR Produced Identification
Personally Known
OR Produced Identification
Type of Identification
Type ofJoentification
Produ d
Prod ce
(Signature of Notary Publ'
(Signature of Notary P
c- a,p,,4 „ [gJft4l KELLEY
CGI76N' Notaryry Pu��Ik Stare of FkAM
+P
s ,commission # FF 999218
;�:.......:
Commission o. Dn(bC@ rt
+�c My CanmiWon GG 170777
Commission No.
-'• o ExpiS@Wd W4,2020
'7 0 14" aonded7 mTroyFainlnsurance 000.395
a 0, ExPIM 01/10=22
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.S/6/20