HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST
hBE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10 -pnnv o v Permit Number:
Sir. [LucDC
LT i i
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: 1(0 K J
PROPOSED IMPROVE�r'i
Address:
1,
`-Oq CO-1
Property Tax ID #: V Li'5 ( - %11 - QO lot - Q 14 Q Lot No. l �,
Site Plan Name: A, V I ItaVdi'rA`LKL Block No. 4r
Project Name:
New Electrical Meter _ Second Electrical Meter
C''NSTR4CTION IN'FORMATIOIV:
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers X Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: _ Sewer _ Septic Building Height:
OWN ER/LESSEE: CONTRACTOR:
Name r- .Q,I� Name:
Address: 0] RA- 1>r Company: 6 S MpnrL G1k� ,I
CiState: EL Address: HkYb6Y 0-r-
Zip Code:. Pbqqr0-1_ Fax: City: D &Uh State.-Pt—
PhoneNo. Zip Code: l00 Fax:
E-Mail: • . ri2."t Phone No
Fill in fee simple -Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License ef-, 1300 (p �}-
If value of construction is 2S1O or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,SOA or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNE
Name: '
Address:
Not Applicable
City: _ _ State:
Zip: ` Phone
FEE SIMPLE TITLE H DER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: — Not Applicable
Name:
Address:.
City: State:
Zip: , Phone:
BONDING
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application tion 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.
Not Applicable
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 our Notice of Commencement_.
I
J
Signatu of Owner/ Lessee/Contractor as Agent for Owner Signature f Contractor/License Holder
STATE OF FLORIDA STATE OF FLOR A
COUNTY OF COUNTY OF CCuI��[.C�
Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization Physical Presence or Online Notarization
this day of ,i�!.:- 2020 by this day of Q(_t ' 2020 by
Name of person making statement. I Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
V\/� I _141mr,
(Signature of Wckary Public- State of Florida
���`�pY A''�/
Commission No. BROWN
.�•R
�P �e� _Notary State of Florida
_� •� Commission # HH 37071
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My Commission Expires
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REVIEWS
COUNTER I REVIEW I REVIEW
DATE
RECEIVED
DATE
COMPLETED
Personally Known
OR Produced Identification
Type of Identification
P oduced
(Signature of ary
Commission No.
MA BROWN
Notary Pu(>>♦ate of Florida
Commission ## HH 37071
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