HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
91E. I LU C LIS
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: E500( IJ\W(QDL-)d (U
Property Tax [D#: 1:301 - (PC- Lot No. 2A
Site Plan Name: Gm') Block No. 46
Project Name:
Lam, r! I- RINI WE% WN M-1,
New Electrical Meter Second Electrical Meter
M04 Svs�"A to
I 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 jZ'Roof 12- Pitch
Total Sq. Ft of Construction: ',2-2-00
Cost of Construction: $ 1, 2_2 Q 00
Sq. Ft. of First Floor:
Utilities: Sewer Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name
Address: emi Kznwad dut,
Name:
Company.Rkadd ek6kg 60, 301tLlk'o-n5
Address: t55q SE 8 All - e-'o-a-
City: R 0LP_V(_C State: r-1
Zip Code: 34-951 Fax: ly l ft
Phone No. __7_1 2-
City: State:
Zip Code: 5qQ5 Z Fa;:::J�_
Phone No -112--
E-Mail: A) [ft
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail 0#1(-1 eD L , (torn
State or County License CC' (!L3,312-&1--
if value of construction is 2500or 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:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip; Phone:
FEE SIMPLE TITLEHOLDER: — Nat 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 perm it.
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 attorney before commencing work or recording our Notice of Commencement.
gnature of Owner/ Lessee/Contractor as Agent for Owner
S' nature o ntractor/License Holder
STATE OF FLORIDA �
COUNTY OF � �-1 V--,,
STATE OF FLORID
COUNTY OF U C
Sworn to (or affirmed) and subscr' d before me of
Sworn to (or affirmed) and subscribed before me of
_� P_ hy, icai Pres�nce or Online Notarization
Physical Presence or Online Notarization
this (_p�' day of (+���i 2020 by
this )3 day of C'' -k6r1 --r- 2020 by
Name of person making statement.
Name of person making sta meat.
f
Personally Known OR Produced IdentificationPersonalty
Known OR Produced Identification
Type of Identificatio
Produce {b u
Type of Identification
N
Produced
(Signature of Notary Pubtic- to lorrc�� Public State d F
nature o o gu i f sar
JTS
Pamela Jonesp�Commission No. • (1*4m mission GG 98547mission +�G 9 )
am Expires06/15/2024 07,expires /15/2024
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 5 6 20