HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Permit Number:
COUNTY
Planning and Development Services Building Permit Application
Building and Code Regulation Division Commercial_ Residential
2300 Virginia Avenue, Fort Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
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Address: l 'L) /(, o C (l K'Jti Li, ✓,"-� � � � / S `J
Property Tax ID #: � 3 / rf - � /O - 0 QU G - �j O o - /�
`� n Lot No.
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Site Plan Name: e L k- %� 0 �r cf n Block No.
Project Name: L) k 0 � � j�agy� f�Pi 1C e l u C � �iy , ��� 1' � c, �
DETAILED DESCRIPTION OF WORK:
R e l v cc�;
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000ff zl O:n o f f e-. C-C '�u
G //a z✓ FJ/
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New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
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:
Sq. Ft. of First Floor:
Cost of Construction: $
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name -5i L , "`c Ccy„
Address: f'o U /co C k A,
f
U
Name:
Company: /' c- re, C • -I/
Address: 1/If- `a /Ii J Ag
City: )57�_' f�G e State:
city: r o l �p �� &C State: rl
Zip Code: Fax:
Phone No. -7-7 " 3 a 'Y - I r O
E-Mail: �-70 Q P�� s f G L'C'Di j C "e �,
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Zip Code: 3 `% r%f Fax:
Phone No 7 '7 z ��3 `f - 3T 7 9
E-Mail A C 1 ee /7 C. A y ,„ lu) (ate 1; ; f �0/L,
State or County License /fIf 6
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
D
ESIGNER/ENGINEER:
Name: _.._ Not Applicable
Address:
City:
Zip: _. State:
Phone
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name: /
Address:
City: -
Zip: Phone:
MORTGAGE COMPANY: — Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
1 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 attorney before commencing work or recording vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLO
COUNTY OF
—M, �� a
Swoyfi to (or affirmed) and subscribed before me of
-/ P sical Pres\ e o Online Notarization
this day of r' 2020 by
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Name of person making statement.
Personally Known J OR Produced Identification
type of Identification ,
(Sigp4ure of Notary Pub)9c- Sta o•.• rt a )
��61&
DANIELLE B. JEWELL
g' Noary Public - State of FI
Commission N;' eal ommission p GG 9373
���
My Comm. Expires Dec 5,
REVIEWS I CFRONTO NTER I REOVI W I SUPERNING REVIEW
I DATE
RECEIVED
DATE
COMPLETED
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
Swor o (or affirmed) and subscribed before me of
_ Physical Pre ce o Online Notarization
this �,. /dray of 2020 by
V I 1 C 1 1 01
Name of person making statement.
Personally Known _�,,/_ OR Produced Identification
Type of Identification
Notary Public- pf Flori a
, ; „ _ n `4� �4 _ ANIELLE B. JEWELL
Nojjpry PyyQQtic - State of Florida
D`lill sion p GG 937394
My Comm. Expires Dec 5, 2023
PLANS
REVIEW I VEGETATIEV EWON I SEATURTEV EWLE I "" REVIEWE
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