HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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: �icy\_ 47S-
Property Tax ID #: 35-35 - fv\. ti? Lot No.
V
Site Plan Name: Block No.
Project Name:yi&k►"liid ✓
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION: I
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: $ I `: -" Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE
CONTRACTOR:
Name
Name:
Address: V—wo .�',:U, (),Aid- TJ(y
_
Company:
City: :J;Awv\ 8&aA State: rr
Address: 3�% l/
Zip Code: -3!j9�'J_ Fax:
City: Sll/Q✓jf' State: —Ell
Phone No.
Zip Code: j qqj 7 Fax: 7'L �7`4�9�i_
E-Mail:
Phone No -1& zsb_
Fill in fee simple Title Holder on next page ( if different
E-Mail ivy) ffla k,
from the Owner listed above)
State or County License
_I
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. g
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
(Q� rOR
3
DESIGNER/ENGINEER: Applicable
_Not 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 Co . and posted on the jobsite before the first inspectio f you intend to obtain financing, consult
with len a or an ttorne before commencingwork or recordi our NOticeoof Commencement.
'4
Signature of r Lessee/Contractor as Agent for Owner
Signature of tontract6rUeWe Holder
A
STATE OF FLO004111,
COUNTY OF n
STATE OF FLORID/
COUNTY OF (VICLv".+J
Sworn to (or affirmed) and subscribed before me of
1 Physical Presence
Sv,or},to (or affirmed) and subscribed before me of
or Online Notarization
this LtBay of QC_f� h� 2020 by
✓ Physical Presence or Online Notarization
flay I.J C1b
this L_± of , 2020 by
ak 0 4�7 oC-++e0
Name of person making statement.
Name of person making statement.
Personally Known n OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Pub - I i
(SignatuW of Notary Public-
1� Pu"•. AMBER L SHIRK
Commission NO. Notar li State of Florida
(
: ��yv a� ., AMBER L SHIRK
+� •`': No��ry, Py lic • State of Florida
Commission No. �' ' � ANsion N GG 243270
(, Commission p GG 243270
3 v ,'? of n My Comm. Expires Oct 23, 2022
e`
�G�� 3 Z ''nor t1` My Comm. Expires Oct 23, 2022
Bonded IbEough National Notary Assn.
ZONING
SUPERVISOR
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PLANS
VEGETATION SEA TURTLE
MANGROVE
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REVIEW
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DATE
RECEIVED
DATE
COMPLETED
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