HomeMy WebLinkAboutpemit appAll APPLICABLE INFO ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
91T. LUC E 7z�el-lre 6avf vicr
r 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: �' L aJr��,
PROPOSED IMPROVEMENT LOCATION? -�
Address:
v
Property Tax ID #:/ Lot No. O?/ a
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 ZGas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ �_ �7!•
OWNER/LESSEE:
Name ..Y
Address.lr "- /„ i
Generator
_ Windows/Doors _ Pond
Sq. Ft. of First Floor:
Roof Pitch
Utilities: _ Sewer _ Septic Building Height:
City: State•E
Zip Code: Fax:
Phone No. 7o2 - 3 0 ' F%5--
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name:_
Company:
Address: LG
City:
Zip Code:
Phone No
E -Mail ss/caQ —
State or County License.
it value or construction is LSUu 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.
State:
Fax:
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFC)RMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address: -'
City: ,Mate:
Zip: Phone r
FEE SIMPLE TITLE HOLDER;/ _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:'`
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:,,'
_Not Applicable
OWNER/9ONTRACTOR 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 Wfnc er or an_attor,Kty before commencing work or recorprin your Notice of Commencement.
Signature of Own
STATE OF FLORIDA
COUNTY OF
r as Agent for Owner
won to (or affirmed) and subscribed before me of
P y ical Pres ce or Online Notarization
t is ay of 2020 by
nIu
Name of person ma�cing statement.
Signature of ContraVr/License Holder
STATE OF FLORID
COUNTY OF 'd A,) '/.
Sworn to (or affirmed) and subscribed before me of
Ph 'cal Pres ce or Online Notarization
t is y of 2020 by
f`ne of person maeng statement.
OR Produced Identification"(Personally Known OR Produced Identification
. r „ Ty6e o le�mtification _ -_'�
(Signature of Nof�;F>ubTi6 St' to TI6rldY)�"'�' I (Signature o ot„
.% 4 Notary Public State of -,
as ; Charmin D Walker }" "11-1
r� Notary public State of Flonda
Charmin b Walker )
Commission No.,.. My Commission GG( 7 Commissions�l(�y. R1 Seal
ti'Qa ,o-xpires 06!06!2022 (' oii E, ores 06/06_" 2227
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