HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I ' Permit Number:
Sir. [Lucm
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 IMPROV-1dW TIO
Address:
PropertyTax I D #: en> +
Site Plan Name: -)I 1 d &\
Project Name:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
�q
Additional work to be performed under this permit —check all that apply:
_Mechanical
XElectric
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ I
OWNERAESSEE:
Addi
_ Gas Piping
_ Sprinklers
_ Shutters
Lot No. 505
Block No.
Windows/Doors Pond
_ Generator — Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _ Septic
Building Height:
CONTRACTOR: Name: Y
s
_ Company: r G
City: t'UY u State I Address:Y' �Y
Zip Code: 1 Fax: i City: &Ad-) State: [--I,
Phone No. �i — f �0 I
E-Mail: rY)AL&_b(tW'rYVr_Vffn
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Zip Code: 3 lan Fax:
Phone No (o JtI'
E-Mail_ft)&n c(xy�p�`j Yea ,�pry�
State or County License_ , i 2XJ0(n1 �a--
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:
i_
DESIGNtE.R/ENGINEER:
Name:
Address:
City:
Zip: Rhone
Not Applicable
State:
FEE SIMPLE TITLE HOLD R: _ Not Applicable
Name:
Address:
City:
Zip: _ Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phote:_
— Not Applicable
BONDING COMPANY: \ _Not Applicable
Name:_
Address:
City:_
Zip:
Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and
I certify that no work or installation has commenced prior to the issuance of a permit.
as indicated.
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 andcovenantsthat 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 your Notice of Commencement.
Signat a of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this _ day of - 2020 by
Moor
Name of plerson making statement.
Personally Known �_ OR Produced Identification
Type of Identification
P uced
ANT—)
(Signature of'ota Public- State of Florida
�R..... MARY B OWN
Commission No. ,,or °°,'- ry Pub1 r e of Florida
•_ Commission # HH 37071
My Commission Expires
REVIEWS
COUNTER I REVIEW I REVIEW
DATE
RECEIVED
DATE
COMPLETED
Signature tiftontractoriLicerise Holder
STATE OF FLO OP
COUNTY OF
S�nrprn to (or affirmed) and subscribed before me of
1�- Physical Presence o Online Notarization
this day of - 2020 by
C-Iu t/ S Moor �
Name of pdrson making statement.
Personally Known _ Y OR Produced Identification
Type of Identification
(Signature of ota
Commission No.
PLANS VEGETATION
REVIEW REVIEW
RE
MARY BROWN
Notary Publi �3� of Flori
-4ommissi�PS AH 37071
My Commission Expires
SEA TURTLE MANGROVE
REVIEW REVIEW