HomeMy WebLinkAboutBuilding permit ApplicationAll APPLICAB E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �D / o _p Permit Number: �) �— �b
�40 1n n�a� J RECEIVED
o l�l OCT 1.2 2020
D BuildingPermit Application
pp PermiVg Department
Planning and Development Services E✓Lucle County
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: a-JJM
Address: M L/. AV 32AJ h S�f FV AT
PropertyTax ID #: �yt�-S-o�� aa3 8'-r�� �� Lot No.
Site Plan Name: Block No. c
Project Name:
Qre,J(bJS �monars N 21 < 'V 1 N br VA -A V-F V ^ goal I TM c.;I
ro v'T "? X i kyr
New Electrical Meter Second Electrical Meter
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: �,_ 0 , sty'" Sq. Ft. of First Floor: q(Z 5'6-' p 0
Cost of Construction: $��/ , 60� Utilities: —Sewer 7zSeptic Building Height:
�kt-t.:,%r
Name «A7 �< < ^
Name:
Address: I AJ i01'�
Company:
City: CA /�/� Statej�
Zip Code:L Fax:
Phone No. 5 / O3 6 Sr.3 O
Address:
City:
Zip Code:
Phone No
State:
Fax:
E-Mail: Ol c rr f ° Coyq
Fill in fee simple Title H er on next paje ( if different
from the Owner listed above)
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDEU Notice oT Commencement Is requutm.
If value of HAVC is $7,500 or more, a RECORDED.Notice of Commencement is required.
�UPPLEMSENTA�ON{S��l`1�T ON IL�N�L�AW'�I��O
4
YW
+IVIA�TI
MORTGAGE COMPANY: _Not
Name:
Applicable
DESIGN, R/ENGINEER: Not Applicable
Name: P- —
ity:
Zip: Phone:
State:
City:��. f -,c« State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY:
Name:
Not Applicable
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 le er or an attorefore commencing work or recording your Notice of Commencement.
Signature Owh"er/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
A4
COUNTY OF
Swor o (or affirmed) and subscribed before me of
Physical Presence gr Online Notarization
this day of 2020 by
iL) N r) f, R Ga 11 i nxL -
Name of persQyf making statement.
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of .2020 by
Name of person making statement.
Personally Known OR Produced Identification / Personally Known OR Produced Identification
Type of Identification a (� Tpe of ridentification
Produced �Ckt�GI ii� Poduce
(Signature of Notar ublic- State of Florida) 'v
(Signature of Notary Public- State of Florida )
Commission No.
ta"yIVI •.;
°*_
AUDREYBCr Ua� HREY
Seal
Commission No. (Seal)
*°
OMMISSfINPRG300817 !
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EXPIRES: March 6, 2023
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