HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Ic Z Z�T� Permit Number:_aol o ,oc&
Building pp Permit Application
Planning and Development Services
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:
PR'OFQSED LMPRO�IEMENT'LOCAT:LON; _
Address: Zcg2-2 6cl G[A&in A61-e-
,PropertyTax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
/dl�Q�,- .� terr/��.,r_ %d 7.Oy /3n/�r Is�,/J/ r t/GJ 1n&1�Al,AJ.
X
New Electrical Meter Second Electrical Meter
CQNSTRUCTION INFORMATION: .'
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:$ SVC Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 6J111er Name: 4'U✓ .t
Address: �Od<> C;,f Company: IS, 5,
City: 162Z,i A3er4 e- State:: Address: 2/�' F Nrr6ar P7r
Zip Code: -711 f-i l Fax: City: 19eir/ State:
Phone No. 7 S— 2.175 Zip Code: 3z,9Wa Fax:
E-Mail: Phone No ?z 6 y3
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed 'above) State or County License G/300/lZz
I
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 MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: ._Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
j 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.
II 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.
I
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 our Notice of Commencement.
Signature of Own essee/Contractor as Agent for Owner Sig7natLYre of Contractor/License Holder
STATE OF FLORI I STATE OF FLO ID 'n
COUNTY OF ( ��1�T1 I�1�� COUNTY OF �( � To���
Sgalr affirmed)and subscribed before me of Sw rn to(or affirmed)and subscribed before me of
1 P Pre nce r On' e Notarization P sical Presenc forrwriiw a Notarization
isy of 2020 by this ay of r 2020 by
CI
6
Name of person making statement. Name o erson making statement.
Personally Known=P OR Produced Identification Personally Known OR Produced Identification
Type of Ide ification Type of Ide tification
Produced -I Produced
'J - h F--- —
> �41ilUUN
(Signature of Notary Public-St ture of Notary Publi -StaW&Elorida)
4ZOZr:Z190 s2i1dX3 a` ���
Commission N 9Ls J a uoiss�wcuo�uyy `� W Ae� (�1� oPubhcStzt
H fission No. s
6ui){huellps ntta;44F
2ruol�jo a1'1�ogQnd kBION h`' MY C
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLIE—
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.