HomeMy WebLinkAboutbuilding permitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: et-- (5� Permit Number:
M, LSLEC
L-LCrCt�f
c L C VV L c A- ^ r-Y Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial 1z Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENTtt LOCATION:
Address: n1 �r/_
Property Tax ID #: Lot No._
Site Plan Name: _e L-c0�-nc- Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter k/ Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
chanical _ 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 Construction: $ Utilities: —Sewer —Septic
Building Height:
OWNER/LESSEE:
CONTRA TOR:
Name C-�r� ��
Name: 6/�i3 t�.��
Address: 0 S 1 tj �w v, '�
Compan : c� 2 c
City: Pt -P. ev cr State: �
Zip Code: Fax:
Phone No. M1
,
Address: -7 t � -��
City: i�iY t� State:
Zip Code: pi � Fax:
Phone No t ',,-- 70 �--i C 31
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-M
State or County License eCl 3002753
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.
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:
Address:
BONDING COMPANY: Not Applicable
Name:
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.
Lucie County and posted 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.
Signature of Owner/ Lessee/Contractor as Agent for Owner
' nature of Contract Icense Holder
e0RIDA
STATE OF FLORIDA
STATE OF
COUNTY OF
COUNTY OF
Sworn 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 day of 2020 by
this day of iscu� 12020 by
rse M S l t� -J&
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification J
Type of Identification
Produced
Type of Identificatp*i9n
Produced F' C'D t.
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No.;ot�YP�e�•..(SeaI)SANDRAROTKISKE
; Notary Public - State of Flori
9 O:commiW
" F My C
mm. Expires Jun 30, 2
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Rev. 5