HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 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:2
PROPOSED IMPROVEMENT LOCATION:
K
Property Tax ID #: b -- GAD-769-000 -0 Lot No. _
Site Plan Name: Veafu rc (i U4- A+ 10 d "al) IF 1 ✓tr Inc Block No.
Project Name: C oS c, I Iy e I c. & s; d eel c-e
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 _ Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers _ Generator oof Pitch
Total Sq. Ft of Construction: f i sSq. Ft. of First Floor:
Cost of Construction: $ 0/ 00L' . 0 Utilities: —Sewer _ Septic Building Height: I
OWNERAESSEE:
CONTRACTOR:
Name van Cu SLu I 1 v e 1 Ck
Address: I (0 3 3 I S� $0't"T-5
Name: AZ A m`ft
�'14C �I-
Company: n tr
cti rl
City: 0 i a M 1 State: 1--7-1-
Zip Code: _'S 31 9- S� Fax:
Phone No. 401" e
Address: 51 31 N
I `v� hi e_
City: r%a✓-t- L4 ✓J,, r du
Zip Code: 3333'-A
Phone No (A I - 100
5
I e State: F L
Fax:
'(P I (]
E-Mail: -S Gi A'l e
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail Z2 ►n L h ®
mlll 1• 60
State or County License PC
C, L31-k O
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:
NGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: — 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.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Coun 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 Cou ty and posted on the lobsite before the first inspection. if you intend to obtain financing, consult
wi1ih , bnc r or an attorney before commencing work or recording your Notice of Commencement.
Owner/ Lessee/Contractor as Agent for Owner
SPATE OF FLORIDA .1
COUNTY OF M d rt
Swor o (or affirmed) and subscribed before me of
P cal Presence or Online Notarization
this - , day of US � 2020 by
Name of person making statem
Personally way O oduced lde tification
Type dentificatio
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
I- r
Sworn or affirmed) and subscribed before me
of
h�rsical Presefe or4 Online Notarizati
thisITNY of 2020 by
wow�Q
'ent.
Name of person m=OR
Personally KnownProduced Identifi
on
Type of lden�ification
;T
Pry�".�..—��
of No%iE'ry Pub- State of Florida
1-1 12� h �:�r+= Notary P blic - State Df riond A, - - _
Commission No. Comr"ssio(S8i§1)9 ,3' Commission No.46r I�17 1 (Seal
- }Gttdod c`h,oL•'oh NaWnn3i f -o Cry Ass.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVER
DATE