HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BL-,.:�MPLETED FOR APPLICATION TO BE ACUri'ED n
Date: Permit Number: QV0� _nq q 0
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:
PROPOSED IMPROVEMENT LOCATION:.
Address: 5 N V5- d PI h-e-5
Property Tax ID #: g)J—z- 1 -
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
122bU I Av.1'-,+Lh GI /Pre ii
NO V b&i rew, oVed
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
52
m < —1)V1 Sb
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 of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 2— 20 0 Utilities: —Sewer _ Septic
Lot No.
Block No.
Building Height:
Pond
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name (- I Gl a
WK6fAVIV
Name: e
Address: Rho
ne's cArck
Company:
City: P me
State:?L
Address:
Zip Code: �J� "I S Fax:
City: State:
Phone No. �Jl'(p -�J�OZ y�y^� �i�
Zip Code: Fax:
E-Mail: I? I -L2n M l &�
Q. � W, COYH
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail
from the Owner listed` above)
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.
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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 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 attornev before
of Owner/ Lessee/Conyactor as Agent for Owner
work or recording vour Notice of
Signature of Contractor/License Holder
STATE OF FLORQJi STATE OF FLORIDA
COUNTY OF a�-YY i c�� ja ; J sr 1COUNTYOF
S -to (or affirmed) and subscribed before me of
t7hysical Presence or Online Notarization
this V6 d�y of q m S 2020 by
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of . 2020 by
Name of person making statement. ( Name of person making statement.
Personally Known XOR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public- State f Notary Public State of Florida)
r�11 MICHAEL LETTF[eCommission No.GG�6 Rb69 � Q MYCOMMISSION 1:EXPIRES:No. (Seal)
.. .
REVIEWS I FRONT ANGRO
COUNTER I REVIEW I S REVIEW UPEVISOR I REVIEW PLANS I VEGETATION I S REVIEWLE I M EV EWVE
RECEIVED
DATE
COMPLETED