HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
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�± 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) L62-1578
PERMIT APPLICATION FOR: �_ cG-1
PROPOSED IMPROVEMENT LOCATION:
Ae^1i] tic- . C.C, cxc' ,k! -�K_
Address: 3kI e tP �� +. L. c, �
C; k r. ti— Cd �` 1 L,14 1 — S _..S,' -I
Property Tax I D #: - 5 c, 1 - u -1 - c, e - 7 Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
Block No.
� ti �� � � � fir•• � 1 c�.
�c -i t
New Electrical Meter Se and Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
Mechanical
r Electric
_ Gas Tank
Plumbing
Total Sq. Ft of Construction:
Cost of Construction:
OWNER/LESSEE:
_ Gas Piping
Sprinklers
_ Shutters _ Windows/Doors Pond
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
CONTRACTOR:
N a m e '1'lr\ r Gb�
Address:-13'�,'
City: C e C t � State: n 3
Zip Code: c: '60- 1 U Fax: --
Phone No._[rcn r,;,)1 -5S Inca
E-Mail: cYN J, c i,o-rv�ha�S 1Ubid'�� s
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:
Address: -)Icio r u ►1 *(-0. -A,,C-
City::w�'�-d� State: k:'4-
Zip Code: Fax: —
Phone No 61 c_ 0-7 � - c• �`
- � t.r-' L• : it �t33
E-Mail') L1�c, 5733 0
533�
State or County License(,,,,
12- - t 3c%
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:
Name:
Address:
City:
I Zip: Phone.
FEE SIMPLE TITLE HOLDER:
Name:_
Address:
City:
Zip:
Phone:
Not Applicable
State:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:.
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
Not Applicable
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 tl-e 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 of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF f-J\a ,
Sworn to (or affirmed) and subscribed before me of
✓Physical Presence or Online_ Notarization
this }"#Aof n. epki{-.1,: ,- 2020 by
e of person making statement.
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
- Physical Presence or Online Notarization
this r'V of t::.v�u4-e.�ri���.,� , 2020 by
e of person making statement.
Personally Known t' OR Produced Identification Personally Known L-= CR Produced Identification
Type of Identification Type of Identification
Produced S c�r,yc Produced
(Signature of Notary Public- State of Florida) (Signature of Notary Public- State
Commission No.CTG cf
(SeKqZENCODERRE
MY COMMISSION k GG 981001
sa. PIRES: ril 23, 2024
'6 ... Bonded Th 'Notary Public Underwril rs
REVIEWS FRON
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev�iT�
mmission No�6- `I � 100 t
IUIREN CODER RE
a r COMMISSION # G 1001
EXPIRES: April 23.2 4
Bonded Thru Nalary PuNir I I raw
REVIEW RE EW VREV EWON ` S REVEWLE MANGROVE REVEW