HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMF FOR APPLICATION TO BE ACCEPTED = l\
Date: )offff. o20
ST.LC1CtE ,�;
F L O R I D A
Building.Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Commercial Residential
PROPOSED IMOROVEMENT LOCATION
Address:
aOb-7 -63
Property Tax ID #: f?L+Q 3 - fsdS-GG.S9-• � -5" Lot No. 20 AL)n 1`l
Site Plan Name: Block No. --
Project Name:
DETAILED DESCRIPTION` OF. V1%'ORK:
New Electrical Meter Second Electrical Meter
CONSTR, UCTION INFORMATION
Additi al work to be performed under this permit- check all that apply:
Mechanical — Gas Tank — Gas Piping — Shuttersz-
VElectricWindows/Doors _Pond
Vlumbing —Sprinklers —Generator �oof 6 2. Pitch
Total Sq. Ft of Construction: %— Sq. Ft. of First Floor: /,S7
Cost of Construction: $ %C n,. pG Utilities: Sewer Septic Building Height:
—� — — - .
OVgI,I�ER/L�SSRE
CONTRACTOR:'
_Name-C— caA~z4Z Am ADo OL
Name: mAgk ixylriuS
rzo A i6" 1'Av E
Company: A I3AC6l�
. Ca.v.S71zUc7
;City �Qg�`"�, f l'MC� r G` ,
State:
Address: X;5
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City: LIC-ST
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Phone'No: %72-.�%�f �GS�6° .:
Zip Code: �3y6 ci
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E-Mail: ��2 9/ L1T YGLC'
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'Phone No(,S(1
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Fill in fee simple Title Holder on next page (if different
E-Mails 6AW 440
ors ICQc71Gw4 6-3 H AlL
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State or County License_
from the Owner listed above)
It 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 CONSTRUCTIONI'IEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: 1V0'C("`'"'%
Name:
Address: C006
Address:
City: w . 2. {3 State:
City: State:
Zip: 3-'qo Phone �inl� 2�15�tz12'
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 andposted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or apeatto—p-h-e-V before commencing work or recording vour Notice of Commencement.
Signature of Ow er/ for as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF _S'T- Lo c 1,e CMy 7 W
COUNTY OF ST. L-&Cle e6oAg V
Swop to (or affirmed) and subscribed before me of
Sworn to (or.affirmed) and subscribed before me of
V Physical Presence or Online Notarization
__L.Ahysical Presence or Online Notarization
this j_q day of wmC . 2020 by
this _8 day of _JOL16 , 2020 by
C_rL6-A'ZA12. AMAOCK
MAfLIx SC-0Kl0S
Name of person making statement.
Name of person making statement.
Personally Known iz OR Produced Identification
Personally Known _/ OR Produced Identification
Type of Identification
Type of Identification
Prodd` �
Produced
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tary-Public- State of Florida)
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