HomeMy WebLinkAboutBuilding Permit ApplicationAll 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 I Commercial V� Residential
2300 Virginia Avenue, Fort Pierce FL 349�2
Phone: (772) 462-1553 Fax: (772) 46?-1578
PERMIT APPLICATION FOR:
I PROPOSED IMPROVEMENT LOCATION:
Address: 6n . Ocean Q Un°
Property Tax ID #: H 00 (o 3 — 00Q — 8 Lot No.
Site Plan Name: B0, lawi".-A-et Block No.
Project Name: h e
DETAILED DESCRIPTION OF WiORK:
c c /g fiM
New Electrical Meter Second
Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed L
_Mechanical Gas Tank
Electric _ Plumbing
Total Sq. Ft of Construction: L
Cost of Construction: $ a j o o a.
r this permit — check all that apply:
—Gas Piping _ Shutters
Windows/Doors Pond
_ Sprinklers _ Generator — Roof Pitch
Sq. Ft. of First Floor: , IVY
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 0' lQ\,
In
Name: Edvi-a.rd► sm'LA- N
Address: C) S.
City: 79.09Qn Qg h
Company: C. SMi33a el c'— r1 c_
Stater
Address: 5Ao 7 0—akl.nd /,a ke C jr
Zip Code: 3 4 ciS- Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page
from the Owner listed above)
City: Ff. Pt' P(e State:FL
Zip Code: 3 Li q.S/ Fax:
Phone Now/ ) L/ sa —g//-7
( if different
E-Mail
State or County License i /y 3
_ __ . _. , . ...,,.._, a wvLwc V,-Ummeticemerix 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: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
city:
Zip: Phone:
Zip: Phone:
OWNER/ rnNTRnrTnR ACGfnXnT. e_�:_._
-- - - - • -• • ha• mi'V 'maul-- -b -�C' euy made io ooiam a permit to do the work and installation as indicated.
that I certify t no work or installation s commenced prior to the issuance of a permit.
St. Lucie County makes no representation ghat is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Honhe 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, thq 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 financin consult
with lender r an attorney before commencing work or recording our Notice of Commencement.
ti
Signature of Owner/ Lessee/Contractor as
Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF S 7- Luc
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before
x Physical Presence or Online Notarization
•�
this ! R day of Se neM be r 2020
me of
by
Sworn to (or affirmed) and subscribed before me of
X Physical Presence or. Online Notarization
this 10 day of S-'0,0 m b e e- , 2020 by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification_
Type of Identification
Produced Or, iC
Personally Known OR Produced Identification
Type of Identification
Produced 0 ,. L;
Netacp aUblu, SEatr cP Florida
hRona L or,
Mona Leon
Fifotary Public State of FiopcM
My Commission GG Mw3
(Si nature of Notary P 3agle i , 6_774977.77,
Commission No. Z3 (Seal)
(Signature of Notary Pu
Commission No. Z— (Seal)
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Rev. 5 6 20