HomeMy WebLinkAboutPermit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �S - « � � C7� 0 Permit Number:
a
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300Virginicr Avenue, Fort Pierce FL 34982
Phone: (772) 462--1553 fax: (772) 452-x.578
PERMIT APPLICATION FOR;
d q'W"3
Address:
Property Tax !D #90
Site Plan Name:
Project Name:
Commercial Resi.den
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0
tial
Lot No.
�
Black No. (0�,,.
9
Ike -F� <-' l � 1C -e __r' hC✓)
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New electrical Meter Second Electrical Meter
Additional work to be performed under this permit- check all that apply:
ql�mechanical � Gas Tanis Y Gas Piping � Shutters
electric
_Plumbing
Total Sq. F
Cost of Construction: $ �_
Sprinklers _Generator
Sq. FY. of First Floor:
W"Indows/Doors
Roof
Utilities: Sewer I Septic Building height:
Nameeot C,�`4'1 i�� brier1
Address:"""")
City: S L,_ State:471
Zip Code: Fax:
Phone No.
E -Mail:
dill in
dee
simple
Title Holder on next page ( if different
from
the
owner
fisted above)
Pond
Pitch
Name: LC� L2 /
Company: 7r-0 if T.�fM
Address: y FY(O 5LD Cb.(r)-i,I-ON
City: State: iE.�
Zip Code:3�'d4 Fax:
PhoneNo7'%D'�oU%- 1��-7
E- Mail +TL) C+fCY_4P nrkAa,
state or county License C-,nc� o I
Eif value
of
construction is
2500 or mors a RECORDED Notice of Commencement is required.
If value
of
HAVC is $7,500
.or more, RECORDED Notice of Commencement is required.
-A
N .4%
0
I
DESIGNER/ENGINEER: � Not Applicable
Name:
Address:
City: S
Zi P:
Phone
FEE SIMPLE TITLE HOLDER: _Not Applicable
Name:
Address:
city:
Zip: Phone:
MORTGAGE COMPANY: _Not Applicable
Name:
Address:
city: State. ,
Zip: Phone*
BONDING COMPANY: _Not Applicable
Name.
Address.
City:
iP: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the wank andInstallation as indicated.
I certify that no vuor[c or instaliation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation khat is granting a permit wil! authorize the permii hol der 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, its 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 oncurr nc review: room additl ns, .
accessory structures* swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TQ OWNER: Your failure to Record a Nonce of Commencement may result in -paying-twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of 5t.
Lucie Countnd posted on the jobsite before the first inspection. If, ou ir�tend to obtain financing, consult
wi�kh lendeur a�attarnev before commencing work or recording ur notice o�Commencer�e��.
s,gnatLlrepo'of owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF a Q,
Sworn to dor affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of , zozo by
edLo; n 44.
Name of person matting statement.
Personally Known OR Produced I dntifi cation
Type of ident'ifi at oun {
Produced
'-w
(Signature of Notary Public- State
Commission No.,
r
on
Signature of Con.tracto5
STATE OF FLORIDA
COUNTY OF
cense Molder
worn to dor affirmed] and subscribed before me of
Physical Presence or Online Notarization
6is.W4 day of _ _ �[1AIr.S__�____�_- 2020 by
Personally Known OR Produced Identification
Tyke of Identification
Produced
(Signature of No
orir assion. No.
FloriaMAria RaIMUndl
1
Comm. -.9"A 5#GG322� 2D;
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fgpr Thu Asron Not
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COUNOTER
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DATE
RECEIVED
DATE
COMPLETED