HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a I -I Z, Permit Number:
0
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:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #: �L%-CJ f brMQ C Lot Na. VU
Site Plan Name:
Project Name: _
DETAILED DESCRIPTION OF WORK:
S f
/4M6k I r-A N aJ_r3,C 9 -VJ J h, 4-) 5 9
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additio i work to be performed under this permit -check all that apply:
iz
7echanical _ Gas Tank _ Gas Piping _ Shutters
Electric _Plumbing _Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $;U
Generator
Sq. Ft. of First Floor:
i:7MWi,n
Windows/Doors _ Pond
Roof Pitch
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name AMA-5 _ � � iiW 4,
Name: � C -1 ,. i ,_
Address:1A �j�� ;o„� �;
Company: Lg �Gmwq 17/ 1�L
City: �/aJ_S0l�`I State:C�-,
Zip Cade: OC'6f Fax:
Phone No._ d o,3 C i __C C v
�ry
Address: AA1a
City: ag_ Sr L iC State:
Zip Code: vT-7�' Fax: K
Phone No �'7� Zvi' `aq1
E-Mail:_ iU ZJJ o / A_T-
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License C C'o 4911 i J 6' 14 q I
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required -
If value of FIAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE: COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 I@nder or an attorney before commencing~ work or record your NQti.ce of Commencement.
5tgnat r O ner/ Lessee Contras or as Agent for Owner
Sig Aatur ant ctor/License Holder
STATE OF FLORIDA� ,
STATE OF FLORIDA
COUNTY OF
COUNTY OF,
Savor o (or affirmed) and subscribed before me of
i
Sworn o (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Presence or Online Notarization
thisDqday of 2020 by
this day of 0j.A 2020 by
Name of person making statement.
Name of person making statement.
Personally Known VOR Produced Identification
Personally Known c--'--OR Produced Identification
Type of Identification
Type of Identification
Produced
�]E� A A I ( /' 2::�
Produced
(Signature of Notary u lic- State of F qr a) FRANCEsy_aOANS
(Signature of Notary Pub I State of Flori!�o, ", FRANCES
YCOMMISSfON#GGP
Commission Nv.�,Cb"3�I EXPIRES: or(DW29. 2i1
N
a� U.,lO
038 � ' o MYCOMMlSSiON#
ommission No. �__ - - - - — - -
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_114OP," Bomed ThD bWpt Notary S
N� EXPIRES: ChUober
9rFOF e4Q`�� Bonded Thr3 tl cdget Na'
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 5/6/20