HomeMy WebLinkAboutBuilding Permit Applicationi
All APPLICABLE INFO MUST BE CO!1` .,y _.TED FOR APPLICATION TO BE ACCEPTED- `
Date: �4 � Q _L� Permit -Number: �o —
RECENED
SEP 2 2 2020
Building Permit AppIiCiLtikallDepartment
Planning and Development Services fit, Lucle.County
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: 2 K/ 3
Property Tax ID #:
Site Plan Name:
Project Name:
C.o,_vcE,e_(_
Commercial
N.
(V2s-60S-00sk-ow-.r
E f
Residential
P41 f I,
New Electrical Meter Second Electrical Meter '
Lot No. &
Block No. 307�-0
Additional work to be performed under this permit — check all that apply:
a .t
_Mechanical _ Gas Tank _ Gas Piping _ Shutters Windows/Doors _ Pond`
Electric lumbing _Sprinklers _Generator _Roof ;f Pitch
Total Sq. Ft of Construction: I O Sq. Ft. of First Floor: I
Cost of Construction: $ _ ®. Utilities: _Sewer _Septic Building Height:
OWN CAR%L 5S8EE:
CONTRACTOR•
Name S k*401 &, t "`'
Address: 2D03., N� b-a L. 6
Name: Jke4le SD
Company:
City: State:
Zip Code: �' Fax:
Phone No.
Address:
City: r-YL State: I
Zip Code: ���'S� 1Fax:
Phone No
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail q&* Id Dzl- 2-t
State or County Licensel5l 23
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.
7
DESIGNER/ENGINEER: _191ot Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone ,- Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
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 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 lender or an attorney before commencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF COUNTY OFORIDAFLORIDA
C , /
COUNTYOF,�
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed. before me of
. Physical Presence or Online N(atarizgtion
this � y of ��Q 20
Physical Presence or Online N rization
this 2�day ofG 20%�by
a rup__ C505X/
A sc) Ste_
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identificatio
Produced �C,!'�L _��"
Produced
♦`'Y P'/E
of Florida -Notary Public
(Signature of
Commission N
(SignaturefPiSitsai��b.F�P
Commission �i es
�'"0 �` My October 22 2022
Commissio
ELLEN VAUGHN
?_° ��,State of Florida-antssion Public 0079
e�
� My Commission Expires
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