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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE.INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 1� 1 a'a Permit Number: 91ro LLLTQ1� O� �.� ' 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: FIRM,POR E;I M 1 PR AXE107,1 R N,'Mill LOCATION: Address: f o/vIVI Property Tax ID#: ���� �Z ®� g ©2C7 6 Lot No. Site Plan Name: Block No. Project Name:. Mum D =-5C««RIPTION OF WORK: New Electrical Meter Second Electrical Meter CONSTRllCTION INFORMATION: Additional work to be performed under this permit—check all that apply: _Mechanical _Gas T nk _Gas Piping _Shutters _Windows/Doors _Pond Electric lumbing _Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: Iv Cost of Construction:$ / 71c---o� Utilities: —Sewer _Septic Building Height: OWNER/LE�S�S5E: CONTRA TOR: Name ,p Name: K0b(.r ONvJ(,)W Address: . a � . �I''-kl V� . V'�� Company:L--2I/�✓'c7�1� ,o (c9yvt City: ��!>< ��, e✓� State:_ Address: /7 Z'K- S bt, C--t°z" Zip Code: City: -.;0:�. State: Phone No. 7 3 Q'� Zip Code: , G �� Fax i E-Mail: Phone No, "7L S'., �-/;, Fill in fee simple Title Holder on next page(if different E-Mail from the Owner listed above) State or County License &L If value of construction is 2500 or mote,a RECORDED Notice of Commencement is required. If value of HAVC is$7,500 or more,.a RECORDED Notice of Commencement is required. SUPP E TALC*� NS RUCTIO Lt LAW t 1=0 A CAN• 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 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 1 will,in all respects, perform the work in accordance with the ap roved plans,the Florida Building Codes and St. Lucie County Amendments. The following building rmit applications are exempt from undergoing a full concurrency review:room additions, accessory structur s, imming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use WARNING T NER:Your failure to Record a Notice of CommencemeyJres It in paying twice for improv e s to your property. A Notice of Commencement musec de in the public records of St. Lucie C n an posted the jobsite before the first inspection. i to to obtain financing, consult with I n e r n atto a before commencin work or recordinof of Commencement. Signat of Owner/Lessee/Contractor as Agent for Owner Signatur�FLORJQA ontractor/License Holder STATE OF FLORIDA STATE COUNTY O t COUNTY OF to(or it d)and subscribed before me of Sworn to(or affirmed) and subscribed before me of Physi r nce or Online Notarization Physical Presence or Online Notarization this d J 2020 by this day of 2020 by YN-\ gfaI Name o rs n making statement. Name of person making statement. . Person Iry OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced��, ,�`— Produced (Signature of Notary Pu c-State of Florida) (Signature of Notar Public-State of Florida) Commission No. (Seal) Commission No. (Seal) - - ----------------------- ,, ��`: fie REVIEWS ",,,,,, N#GGOUR 'S�OR ?��cP .� m�$ RTLE MANGROVE m 18, Ed✓IE, P d Publicu d?�VIEW REVIEW DATE I'''Fof:�° tlwNotatyPubl n etwmers Iq RECEIVED DATE COMPLETED ev.