HomeMy WebLinkAboutBuilding Permit Application.,4
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: /y 'Z' �� Permit Number: a0l 0 "C>
Building 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: '
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PROPSED IM,PR01/EMENTLOCATIQN..,,n.zr r
Address:
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Property Tax ID #: `/
Site Plan Name: Block No.
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Project Name: IVe—LJ �ri 1PQ._l.l�QsJ
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DETA1LE4D'D:ESVCRI:PTjyION OSF
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New Electrical Meter Second Electrical Meter
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iCONSTRU,CTION,INFOz�2MATlON�u4r,,tf
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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: 1600 Sq. Ft. of First Floor:
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Cost of Construction: $ q, l�60, = Utilities: —Sewer —Septic Building Height:
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am Name:
Address: Company:
City: F-a f-k: Qye r cP State: S�J_ Address:
Zip Code: 2!AL-1 S Fax: City: State:
Phone No. :7-7a D ( Zip Code: Fax:
E-Mail: 0101 Ir, QarvyeEl Phone No
Fill in fee simple Tit Holder on next page ( if different E-Mail
from the Owner listed above) 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.
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:SUPPLEMENTAL CONSTRy.�'IICTI:ON>lEN �LAWINFOgMAfION
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ESIGNER/ENGINEER:
DESIGN ER/ENGI NEER:
_ 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:
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OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and Instanation as MUIGd LUU.
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
structure. PleaseCconsult with applicable
olurHome Owners Association Association
drreview your deed for any restrictions whichtrict may alprohibit such
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
b f encin work or recording our Notice of Commencement.
with lender or an aLLO, ney a ore comm
p a'C
Signa use of Owner/ Lessee Contractor as ent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
c
COUNTY OFF
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Pre�nce or Online Notarization
Physical Presence or Online Notarization
this—- day of C�90 2020 by
this day of 2020 by
Name of person making statement.
Name of person making tatement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Pro ced
Produced
(Si a re o Notar Pi�l�� -
(Signature of Notary Public- State of Florida )
. t-IASHAHNAINGRAM-RAaIMIN
)
.-
Commission No. i^ : MYCOi�Mf Q��#GG275060
Commissiori,No. (Seal)
EXPIRES: December 20; 2022
8ondcd'Thru Notary? b1i0Ur1ddN,"f1t0TS
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Rev. 5/b/ZU