HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: %U s-Ld Permit Number:
G0 �,
RECEIVED
ST. LUCI
OCT 0 5 1010
Building Permit Application Permitting Department
St.Lucie County
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: .
PROPOSED IMPROVEMENT LOCATION:
Address: 2;493- ST zz"_ v- /3C�ld 4411 �y
Property Tax ID#: I&IZP-7az- ��rt,3Z !Zo-c) Lot No.
Site Plan Name: Block No.
Project Name: ;
DETAILED DESCRIPTION OF WORK:
New Electrical Meter_ Second Electrical Meter
I'CONS'TRIUCTI' 'O'N'INFOR'MATION:
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: $ Utilities: -Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name /�,���„,_ Ki��c�V Name:
Address: Zr/ss j? 341W elwl Z Company:�,f
City: a11 1-.Ie— State:I!Z_ Address: ZIV C'//<,K 4L e
Zip Code: _��/91/� Fax: City: AZA State:,J'
Phone No. Zip Code: '17wao Fax:
E-Mail: Phone No 777, 4q? /9dS
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License A /30'w Z z
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.
SUPPLEMENTALCQNSTRU.CTION,LI,EN;-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 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 Owner Lessee/Contractor as Agent for Owner Signature of on actor/License Holder
STATE OF FLOSTATE OF FLORIDA
COUNTY OF �J' _��(A COUNTY OF .L_ICr
worn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presence or Online Notarizationysical Pre nce or line Notarization
this day of (� �� ,2020 by this day Y 2020 by
4LIU MOD it e
Name o person making statement. fame of PdVs6n making statement.
Personally Known�a OR Produced Identification Personally Known OR Produced Identification
Type of Ide tifica Jon Type of Ide tificat'o
Produce d° J - Produced
(Signature of Notary u lic-State of�Fl rida). "'° _
figno ure of Notary Pu it PLrDtrGfifetdOf Flonda FO%
Notary ubUt:State of Flonda
Commission No. (� ission No. .Brit{�r�yg
i,. �, nrRtrig My��.�Fiif�l sron,HH 012616
t. my commrssron HH 012616 Expires 66/21/2024
Exp ms 06/21/2024
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20