HomeMy WebLinkAboutBuilding Permit Application'- -
All APPLICABLE INFO MUST BE COMPLErtu FOR APPLICATION TO BE ACCEPTED
Date:` Permit Numb r. �00�
a�� I AUG 0
- �1 2020
Y - Building Permit Application r
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ei MictirH I D e pa r t Jr,: t
Planning and Development Services �t,ICic, i
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Commercial Re-sidentlal�____ �1�ity, FL
Building. and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772).462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR
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Address: ��l-LS MAIDL lJCPsPL eL ' 7-S N 'F1. 31-1T
Property Tax ID #: 3 Li Lot No. J QS r—
Block No.
Site Plan Name:
Project Name: SCQ2.W �'I�CLO�tJ�.f V1TN PAUR NQ0ORQQ
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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 _ Sprinklers _ Generator _ Roof 'Pitch
Total Sq. Ft of Construction: TbB 6F . Sq. Ff%,of First Floor:
Cost of Construction: Utilities: Utilities: _Sewer _Septic. Building Height:
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Name -'CLCC��f t4t� - 1.�CRcS`C7 E1 Name: i-�C�ISLR 1=l t�3a
Address:'�)Z�l flAiZ)I QU(A.I`Jt Company:'- 1 0, o
City: State:`I"L , Address: zcse4 c; j
Zip Code: 7Aq 9 S2 Fax' City: " Stater
Phone No. Zip Code: Fax:
E-Mail: Phone No �<p 1) OS `,,V)� y
_
Fill in fee simple Title Holder on next page (if different E-Mail F-/NaS SC CL z� 0
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:' N'ot Applicable MORTGAGE COMPANY: _ Not Applicable.
Name: "PkbL 1,. UO-k Name:
Address: I'tSy T3kt'T s► 1 i q Address:
City: 'P_S _ State: F 1— City: State
Zip: ��k ` t Phone �"Z �1SS�='�i � -Zip; ,Phone:
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
Address:
City:
Zip:
Phone:
BONDING COMPANY:. _Not -Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Avulicat on is hereby made to obtain'a permit to do the work and installation as indicated.
I-ceitifythat in work or installation has eo'mmenced'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' consultwith,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 andaccessory 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 iobsite. before the first inspection. If you intend'to obtain financing, consult
with lend r or an attorney before commencing work or recordin r' Notice oT l,ommencernenm.
Signa r f Owner/ Lessee/Contractor as Agent for Owner Signature of tractor/License Holder .
STATE OF FLORIDA STATE OF FLORID
COUNTY OF COUNTY OF ..
Swn to (or affirmed) and subscribed before me of
Physical Preseme or Online Notarization
this day of 20.20Y
Name of person making statement.
Personally Known OR Produced Identification /
Type of Ideation I _ _ .
Swgrn to (or affirmed) and subscribed before me of
�• Physical P,rqseilQe or Online Notarization
this day of 2 Wby
Name of person making statement.
Personally Known _
Type of Idetion
OR Produced Identification
(Signature of No
1PHREY
(S1 nature of N Public- State of F-lor
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AUDRE
03
MY.EXPIR SSI�15
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Commission No. ;rg' ' °
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AUDREY B.�jVMQP REY
Commission No.
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XPIRES: a 2023 '
OMMISSIO'Pd'�@� 300817
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Bonded Thru Notary Public Underwriters
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EXPIRES: March 6, 2023
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