HomeMy WebLinkAboutBuilding Permit Application (2)All APPLI B E IN MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
g1ro ELCER
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:
PRCQPOSED IMPROVEMENT LOCATION:
Address: If o®.
Property TaxID#: ' �3 �' c�aa -`� Lot No.
Site Plan Name:
Project Name:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
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: L'L 00 b**aCT- Sq. Ft. of First Floor:
Cost of Construction: $ 0 P C;,d7 Utilities: —Sewer _Septic Building Height:
OWNER/LEMS 1
1@ONTRACTOR:
Name l t>ks
Address;: 14 t a 5-'cTne- t RXo6 voovr
Company"'-(1— PIA ig*p I wo—
Address: naofl
City: +4 'Reo'&w : StategL
Zip Code: � ' Fax: -. ..
Phone No.-7.7/" �tO�
City:
Zip Code:' Fax:-M Sr— fz ?-(
Phone No `I~i
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County 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.
SUPP1 I' LEMEN SAL CONSTRUCTION LIEN LAW 1NFORMATfON:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
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 apermit 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 Cou y and posted on the jobsite before the first inspection. you intend to obtain financing, consult
with len ror an att me before commencingwork or recordin our N Ice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signaturarof C ractor/License Hol er
STATE OF FLORIDA
COUNTY OF $-V_ \ J cue
STATE OF FLORIDA
COUNTY OF 5'�'• L�� ��
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
\� this_ day of �� 2020 by
Physical Presence or Online Notarization
th\ day of 2 2020 by
Name of person making statement.
Name of person making sta ement.
Personally Known OR Produced Identification
Personally Known 'OR Produced Identification
Type of IdentjficatiRn
Produced
Type of Identification
Produced L
(Signature of Notary:Pu lic- State of Florida) `
(Signature of Notary blic-State of Florida )
Commission NoLY�"dam-�y�� (Seal)
" M�RIE GIVENS ,r•1>gS.;''' DEANNA
,ion (Seal)
COMISSIORNIE# GGGN'i
R
=
S+:....
•.;c�H;,.•
,w.
P,S'
No
I �U2U
kEVIE
OSR�t�IQ!
!�`
SUPERVISOR
REVIEW
�buqEtTL'E
REVIEW
Bond ELArIMNIS: December
REV
6, 2020
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.