HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO-BE ACCEPTED
Date: Permit.Number.: _--z�
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AUG `'' 42020
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Building Permit Applicati,on
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Planning and Development Services
Building and Code Regulation Division Commercial ReSldeClla( -- -
2300 Urginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772j 462-1578
PERMIT APPLICATION FOR: , A
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Address: ,? S 0 r7 clp P�1,1S A U :2
Property Tax ID#: O `? Lot No.
Site Plan Name: Block No.
Project Name:
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New electrical Meter Second Electrical Meter
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Additional work to be performed under this permit—check all that apply:
^Mechanical `Gas Tank Gas Piping Shutters ^Windows/Doors Pond
Electric _Plumbing T Sprinklers Generator `Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ ,rda - 00 Utilities: Sewer Septic Building Height:
-sSY'-} 4 _ ( uK F" rr `r .:s. 'kms w
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Name CQ i !'l tt S Name:
Address: 5r 3/0 4 n d r e � _+ � Company: '
City: FT; raj QnC Stater Address:
Zip Code: ' �J cj q5`— Fax: City: State:
Phone No. a— 0 T 3 Zip Code: Fax:
E-Mail: ,G°� pe No
Fill in fee simple Title Ho{der on ne pag 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.
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:
ity: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'instaliation has commenced prior to the issuance ofa 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.smh
structure.Please consult with.your Home Owners Association and review your deed for any restrictions which may apply.
4 in consideration of the granting of this requested permit,I do hereby agreethat 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,=nsuit
with lender or an attorney before commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder .
STATE OF FLORIDA t ! STATE OF FLORIDA
COUNTY OF COUNTY OF,- .
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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
Th 70;V d'ay of r _ ,2Q_•bythis day of .20� by
,1 tannet �GtS1•
Name of person making statement. Name'of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced identification
Type of identific turn Type of Identification
Produced Produced
(Signature of N to i a (Signature of Notary Public-State of Florida}
...... � AUDRE!B.Hu Sea!
Commission N :*; MyCOMftd1SS[,h� ,P, EY ( )
* Commission No.
F F,�Q•�: 00
EXPIRES:PJ9rch 6,2023817
Bonded Thru N
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW . REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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