HomeMy WebLinkAboutBuilding permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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P E 0 L Building Permit Application
Planning and Development Services x
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:
PROPOSED IMPROVEMENT LOCATION:
rlrirP«- -7 9" �r ri rY, a U -ate `f�lud
Property Tax ID #: 3Lt l ` — 5 15 C) I R o - C)ob - Lot No.
Site Plan Name: Block No. Z 8
Project Name:
DETAILED DESCRIPTION OF WORK:
-?\,p, a c e_ L4 I a+__ C
tl 3.5 4,
New Electrical Meter
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Second Electrical Meter
Ili .5 secr � o tCa_..� /�V 2,5 +L,,,, n 5,--4-
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CONSTRUCTION INFORMATION: 1
Additional work to be performed under this permit - check all that apply:
)—(Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ ;900O , 00 Utilities: _ Sewer _ Septic
Building Height:
OWNERAESSEE:
CONTRACTOR:
Nametar"
Name: `, arN '4mr,-&e-MQn
Address: ILA k Qd
Company: 4-
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Czy,.k Wr
City: State:�-L-
Zip Code: 3LA99CQ Fax:
Phone No.
Address: ISO ) SIAJ
II
STC�+
City:TSL,
Zip Code: 3qQ t(4
Phone No
State:
Fax:
C� 10
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail 5iarb)i
.
State or County License
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: _ Not Applicable
Name:
Address:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 attornev before commencinia work or recordine vour Notice of Commencement.
Sign ture er/ L see/Contractor as Agent for Owner
Signa re of Co ctor/ ' ense Holder
STATE A
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STATE OF F �!
COUNTY OF �--�
COUNTY OF _
Sw tc (or affirmed) and subscribed before me of
Swo o (or affirmed) and subscribed before me of
Physical Pre nce or Online Notarization
Physical Presence r Online Notarization
tht _1k day of 2020 by
this J)� day of 2020 by
0.rIM Z.�rv�rn-e ms
2 iry, m rn&✓t
Name of person ma=ORProduced
Name of person making statement.
Personally Known Identification
Personally Known L- may/OR Produced Identification
Type of Identification
Type of Identification
PrQdtjced
Pr uced
q I
az
gnature of N y Public S
Notary Public State of Flon
(S nature of tart' Public f
Notary Stale of Florida
Commission No. ,NOTr��ey R Mascola
• (S Mr1ussion GG 95at
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Co mission No. P Tra 2Rl e8�la
Comma GG 9�1
or w Expires o4128I2024
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DIP
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 516120