HomeMy WebLinkAboutBuilding Permit Application-
All APPLICABLE INFO MUST BECOMPLETED FOR APPUCATONT0BEACCEPTED '
Date: PennitNumber
LOME
/
�
'
" ����^U��^��� ��'�&�^�l^���^��K� Building Perm'"="����"" ~"
Planning and Development Services �
ou8d�gand Code Regu��bnDk�ion ��000rDerCial ResidentW` ~
230}Virginia Avenue, Fort Pierce Fl34982
Phone: (772)4GZ'1SS3 Fax: (772)46I'lS7D � !
PERMIT APPLICATION FOR: . '
Site Plan Name:
Project Name:
� -
botN o.
u �
Block No.
^
d,7w.Electrical Meter Second Electrical Meter
Additional work tobeperformed underthispennit-cheokaUthatappkc
—Mechanical Gas Tank —Gas Piping Shutters Windows/Doors Pond
^^�
ElPlumbing 3phnk|en Generator _�_noof
Sq. Ft. ofFirst Floor:
'
Utilities: 5evver Septic Building Height:
RAN
E-Mail
'Ti, -, 11 in fee simp.le Title Holder on next page (if different
State or County License
rom the Owner listed above)
If4alue of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: � Not 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: :I mASt _. 6 4 2/Le r/ -
Name:
Address: Fe LA >e
Address:
City: :;,e_T K e.e_ce GL-
City:
Zip: 3095 / Phone:_V-92-- 4/0S— /13VC?
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.such4`"
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 w`6 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 commencinR.work or recording vour Notice of Commencement.
;a
`SijgMMC re" f Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA �Ct(o('P
STATE OF FLORIDA
COUNTY OF
COUNTY OF
Sword to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
!� P ical Pr n�or,Online Notarization
Physical Presence or Online Notarization
this day of2020 by
this day of 2020 by
Name of pegs n makingtement.
Name of person making statement.
Personally Known Produced Identification
Personally Known OR Produced Identification f
Identification
Type of Identification
d��
Produced
q
(Sig ature of otary u
(Signature of Notary Public- State of Florida ) r'� , •r.• c`^
aVr"ty4 Notary PuNic State of Florida
Commission No. '� TraNsAaLI a
Commission No. (Seal)
My Commission GG 194665
?'f Expires 03n 112022
REVIEWS
FRONT
ZONING
SUPERVISOR PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.