HomeMy WebLinkAboutBuilding Permit Applicationf
All APPLICABLE INFO MUST BE COMF'Lel CD''FOR`APPLICATION TO BE ACCEPTED
Date: !I '� �� Permit Number: -Rm 9 —o (/ WL-�,
COD<,
Buil ing Permit A
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:
Address: 1
Property Tax ID #:
Site Plan Name:
Project Name:
�.SEP 2 8 2020
"r'!QPYI Permitting
Commercial Residential
TCtd d S� --N>OVk s\ LUQ"C_ -P: f'
�WkK-01,10.0I-WD19
r C1� Q L� C� 1
C_
+, o k-A i c:, I I I f A I cl W r o r�
Electrical Meter Second Electrical Meter
Additional work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _Plumbingg _Sprinklers
Total Sq. Ft of Construction:
Cost of -ens rrlctio,n ,$ { 6 .b�►� Ll
Lot No.
Block No.
Windows/Doors Pond
Generator ' Roof Pitch
Sq. Ft. of First Floor: k.% S
tilities: —Sewer —Septic Building Height:'ri
Name e ba "I
Address: Y D Q a�o
City: 1�0�� /s� Ll,e G/ �, State:'
Zip Coder �( 1 s� Fax: Phone NoS . (91 6:;�_�_03 b�?
I
o.
E-Mail: ,/ bn,_Ak WlAsk T"G01
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:
Address:
'City: State:
Zip Code: Fax:
Phone No
E-Mail
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.
• ,r
N
MOE
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 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 your- Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presenpr Online Notarization
Physical Presence or Online Notarization
this 2Z day of 20_ by
this day of 20_ by
Name of person making atement.
Name of person. making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identifi ion
Type of Identification
Produced
Produced
(Signature of Notary Public-
(Signature of Notary Public- State of Florida )
ELLEN VAUGHN
�,,aYP�,�
1P e,.; da-Notary Public
Commission No. �� _State off ssi
_+ # GG 270079
Commission No. Seal
(Seal)
+_ Commissiddn
='oQ � My commission2E0x2 sires
WON \92.
REVIEWS
FRO
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW .
-REVIEW,.:: ,
REVIEW.- ,
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.