HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number: 7.609r— 006'l
9Uo
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: 451d // i 4
Property Tax ID #: q7 3 ' .���� 6� ��Oa �' Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ - ! 000, do
_ Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
_ Roof Pitch
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name ' v LL/p r AZd I%>T
Name: &AKZVQ �'-c® d > •-T4X
Address: �� �GAG�
Company:
City: fir)State:
Address:
City: C> State:
Zip Code: �25&0 Fax:
Phone No. 77Z . 4 `i ���'.�'
Zip Code:' ,��� %,3 Fax:
E-Mail:
Phone No 72 Z.-- Z15- eam
E-Mail
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License C CSC 06/ 1,3 3
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:
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name: 41 --lN J/�(�
L -6
Name:
Address: 02* ,Slt9 DCmAj
�,r/ .
Address:
City:
State: OC�r_
City: State:
Zip: IQ Phone 7,zZ
ZOO *2/
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 attorney before commencing work or recording your Notice of Commencement.
Signature
STATE OF FLORIDA
COUNTY OF �,
ntractor as Agent for Owner
SW rn ,a -(or affirmed) and subscribed before me of
Physical Preseor Online Notarization
this
IQ dayn a`of 1 / 2020 by
Name of person makingsent.
Personally Known P d t
Type of Identificati nPgr JULIE BARRETT
Produced '_° •" �:��`: Notary Public - State of Florida
:, •, o; ommasion r GG 243242
My Comm. Expires Sep 28. 2022
Bonded through National Notary Assn.
Ni nature of Nota
ission No.
(Seal)
of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF �S'y Ldcr�
S7n to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this &_ day of jVSj7'_ 2020 by
o/ 1 ,Ave
Name of person making s atement.
Personally Known OR Produced Identification
Type of Identification
Produced
i /r' 7�1sLS1_JL/L�
(Signature of Nota.00
lik
Notary Public State of Florida
Commission No. Shannon O'DonneiL
ommiasi 8323
Expires 08113/2022
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