HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
S' Was
D q '�opf � Building Permit Application
Planning and Devefopment Services
Building and Code Regulation Division Commercial Residential
2300 Virginia A—, Fan Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: Eb WK,-
PROPOSED IMPROVEMENT LOCATION
Address: 7 90S L-:n QS W"k
Property Tax IDB: ''709- 6it/2-000 —3 Lot No. 5e
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK: -
o loot) G u O A rd L ��LC c< fo..E
y rt 5< LOr of 3/ " P 17c .,e...r aY K�Gr.,nlv�-
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this
sp/permit - check all that apply:
_Mechanical _✓Gas Tank Zoas Piping _Shutten _Windows/Doors _Pond
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. FL of First Floor:
a
Cost of Construction:$ `] OoO. Utilities: _Sewer _Septic Building Heigh[:
OWNER/LESSEE:
CONTRACTOR:
Name Fn WPC{-
Name: A'e
Address: 790$ L:n4S W-.,
Company:
City: I.,L S1 L" - State: Ft.
Zip Code: 349 R4 Fax:
Phone No. 54D - • Va SI
Address: 731 511 Greer E- e✓
city: Par L SF . C vr: < State: IYL
Zip Code: 315RU Fax:
Phone No 77a- P3 )- s„o�
E-Mail: 9-.lA 191»L..•s Ql Is- J . Ca..
Fill in fee simple in Holdef'6n next page (if different
from the Owner listed above)
E-Mail g..� 1
State or County Ucense C 05
IINwlue ofHAVCts$7,500 or more,aRECORDED Notice oftonvnencementh requtedY1 �.
SUPPLEMENTAL CONSTRUCTION LI
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
hich
is in conflict with any apDhcable Home Owners Assoaation 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 conairrency 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 rewlt 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
withQlend�er or an attorneybbbefore commencingwork or recordingour Noticeof Commencement.
1.
ljje.
Signature Owner/Lessee/Contactor as Agent for Owner
Signature of contractor/Lkense Holder
STATE OF FLORIDIL
'JI—
COUNTYOF `O�
C.U.TOFORIDA
Swor✓r .ic( affirmed) and subscribed before me of
Swom t affirmed) and subscribed before me of
�1hys�l Presence or Online Notarization
I Prese or Online Notarization
Nis `+-3at'of `�' It(�l] sl3 .2020 by
this_ yof 020 by
�rapl�l�edc�or"
t�nr+i-..to�9c,r��
Name of person making statement.
Name of person making statement.
Personally Known 't/OR Produced Identification_
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Nota Public- State of Florkla I
(Signature
of Nota Public- State of Florida )
Commission 'o~'"�ISFaI)
Comm1551
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EN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
Address:
City:
Zip: Phone
State:_
City:
Zip: Phone:
State:_
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone: