HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COM
Date: 5� aA `aa
�D
11) FOR APPLICATION TO BE ACCEPTED
Permit Number:
Building Permit Appli
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
ion MAY d �i20
ST. Lucie County, Perri
PERMIT APPLICATION FOR:VV
PROPOSED.IMPROVEMENT LOCATIO :
Address:
Property Tax ID #: - zi Q Lot No.
Site Plan Name: ��%5' (� e- E%t Block No.
Project Name:C—
DETAILED DESCRIPTION OF WORK: .(-N
(7 7 650,15 allex _t_,1y e ,P 1C C e-
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be pe rmed under J:Piping
mit - check all that apply:
_Mechanical Gas Tank _ Shutters _ Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
_ Generator
Sq. Ft. of First Floor:
Roof Pitch
Utilities: _Sewer _Septic Building Height:
OWNERAESSEE:
CONTR OR:
Name Ue
Name: u
�p
Address: �� i`Fr�u
Company: IL' fa C
fa S
Q��
City: '1'Y o- l Z State: F
Address: 41005 v
t
Zip Code: 5 Fax:
City: dC[JCa.i-(
Stater
Phone No.
Zip Code: Fax:
22.0 zll�
E-Mail:
Phone No `7 2 - 2-0
(01(0
Fill in fee simple Title Holder on next page ( if different
E-Mail o l i c v? 4
a
from the Owner listed above)
State or ounty 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.
C
1
S,UPPLEMENTALCONSTRUCTION, LIEN. LAW. INFORMATION
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:
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 d)your property. A Notice of Commencement ye-v),ur
be recorded in the public records of St.
Lucie County Od osted on thoobsite before the first inspectiyou intend tp obtain financing, consult
with lender o a attorney before commencine work or recordi Notice of/Commencement.
raall'� i
Signature of O ner/ Lessee Contr r as ent for Owner
Signature of Contractor/Licen46 MIder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY
Swgfn to (or affirmed) and subscribed before me of
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Sw n to (or affirmed) and subscribed before me of
Physical Presence or .Online Notarization
this j/Lday of 2020 by
Physical Presence.or -Online Notarization
this 27— day of {IMCL!4 .2020 by
Name of person making statement.
Name of person making statement.
V
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Si nature of to Pu
(g ry teNo$f )
Produ d
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(Signature of N ary Puf df Qly
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IdOG 908661
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