HomeMy WebLinkAboutBuilding permit applicationAll APPLICABLE INFO MUST
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�BE COMPLETED FOR APPLICATION TO BE ACCEPTED 01
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Date: (� `ct-2�0 Permit Number: �%' vO(
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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: `P
Property Tax ID #: boo Lot No..
Site Plan Name: TD AMYAPAhTfir Block No..�
Project Name: ^ t/ 1
DETAILED DESCRIPTION OF WORK:
New Electrical Meter
Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters '1Nindows/Doo s _ Pond
Electric Plumbing _ Sprinklers Generator Roof 7/��� Pitch
X —
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ �� • d!% Utilities: _Sewereptic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name LGG
Name:
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Address: C O b
Company: m � ��m If
City: V/. PIERTA State.
Address: 1 1 (,VA
Zip Code: Fax:
City: F Stater
Phone No.171-tgo -?a q
Zip Code• Fax:
E-Mail:
Phone No -
Fill in fee simple Title Holder on next page (if different
E-Mail 1 *
from the Owner listed above)
State or County Licenset✓
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:
oe
DESIGNER/ENGINEER: , Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: C f 'C G we .
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone --
Zip: Phone:
FEE SIMPLE TITLEHOLDER: 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 attornev before commencing work or recording vour Notice of Commencement.
Sign ure O er/ Lessee/Contractor as Agent for Owner
Signature f ntractor/License Holder
STATE OF FLORIDA
lJ�
STATE OF FLORIDA
COUNTY OF
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
V'
Sworn to (or affirmed) and subscribed before me of
Physical Presen or Online Notarization
this day of 12020 by
Ph sical Presen or Online Notarization
this ay oft2020 by
/
i ail
Name of person makingulatement.
Name of person making6katement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification ,,,//
Type of Identification ��//�� rr
Produced u_��l'
,�r
Produced F—L 0 G
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(Signature of I' -Sate of Florida)
(Signature of Notary Public- tate of Florida )
`P�PFY P0�4 E L L
Commission '_°` °==S iorida-I�$gar'y public
Commis on,,Np�, �� �^ "AUGH
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'= Commission # GG 270079
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�_° ��:State of Florida -Notary Public
'%�OFiI°Poi My Commi
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ctober 22, 202
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lev.516120