HomeMy WebLinkAboutBuilding Permit Applicationi L NTAL CONSTRUCTION LIEN LAW INFORMATION: ;
rDESIGNER/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 thepermit 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 our Notice of Commencement.
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Signatu o caner/ Lessee/Contractor as Agent for Owner
Signatu �of Contractor/License Holder
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STATE OF FLORIDAf
_
STATE OF FLORIDA CI I
COUNTY OF
COUNTY OF �T
Swo"(or affirmed) and subscribed before me ofSwor
to (or affirmed) and subscribed before me of
Online Notarization
Physical Presence or Online Notarization
2020 by
V Physical Presence or
this � day of 2020 by
this—day of
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dC ay<' C Mc
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Name of person making st ement.
Name of person making statement.
Personally Known �_R Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
a
(Signature of Notary Public- State
i ure of Notary Public- Sta
"w Public State of Flori
,
PAY%i Notary Public State of
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Commission No.C'1GaIL1�g- a%l) Margaret E Montep
vt� Notary
lorida 4 Qq aret E Monte are
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reCom Sion No. .(SSI bommisaion GG 21499
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~'dor ted' Expires 06/05/2022
21 990 Expires 06105/2022
REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
All APPLICABLE INFO /MU�\ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (l ho -/ ' 269 (' Permit Number:
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:���('
Address: 111 / l;�> - L -s n1 7 I1 L e, 6e ,
Property Tax ID #: � '7 3�� 33 - 600 3 - 01 Q -s Lot No.
Site Plan Name: Block No.
Project Name:
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit- check all that apply:
_Mechanical
_ Electric
_ Gas Tank
Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
— Gas Piping
Sprinklers
_ Shutters
_ Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Utilities: —Sewer _Septic Building Height:
Name unV/S-M Q) 2Q Y- -Jcflf_S
Address: 4y
City: YC_. l ie;,, -'CQ, State: F/.
Zip Code: 3L!' l�� Fax:
Phone No. 9 5 y - � 1 & - 72,? k
E -Mail: JwiS 1Qnes '-�' 60�SOLP�I
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:1.1 tttLL! 1
Company: }t'��LAO, �_ ecC rICQ) CL61rox Y\
Address: I610 W' e
City: . PIe-rG -' � State Cr
Zip Code: -3 q `7 b c2 Fax:
Phone No 1-11n /- 9
E -Mail i 17 e1 -\1T K14U Q
State or County License i=C 1 UCS 1 CD43
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.