HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO -MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number; A ,
Building. Permit Application
Planning and Development Services JUL 0 2020
Building and Code Regulation Division Commercial Resi w'ilE - 9
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED -IMPROVEMENT LOCATION:
Address,.. ZQ o8 nI1�2G
Property Tax ID-#:'� (�
Site Plan Name:
Project Name:
DETAILED• -DESCRIPTION ,OF WORK:
.A _
New Electrical Meter Second Electrical Meter
Lot No. 40
BlockNo .,,,
CONSTRUCTION INFORMATION: I
Additional work to be performed under this permit —check all that apply:
_,Mechanical _ Gas Tank —Gas Piping _ Shutters —Windows/Doors _ Porid
_ Electric _ Plumbing _Sprinklers _ Generator — Roof Pitch.
Total-Sq. Ft of Construction: Sq_ Ft. of FirstTloor. _
Cost of Construction: $d • r Utilities: _Sewer _Septic
Building Height:
OWN ER%LESSEE:
CONTRACTOR!
Name
i�s
Name:
Company:
Address:
City: 2t s-ZA64421 - State:
Address: 49D2
Zip Code: SON Fax:
City: - tS704441State: a
Phone No..9002 / 70' y8 Qg
Zip Code:; Fax:
E Mail:
Phone No ;129 4103 •,OV 90
Fill in fee simple Title Holder on next page (if different
E-Mail X47JY Q A&4— e ow
from the Owner listed above)
State or county License Cig fn /a?&
If value of -construction is 2500 or more, a -RECORDED Notice of Commencement is requirea.
if value of HAVC is $7,500 or more, a RECORDED Notice of Commencement IS required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEE •
Not Applicable
MORTGAGE COMPANY: ' Not Applicable
Name:"Ag:
.,c
Name: /(J A
Addres : 60
Address•
City: av
State:
City: . State:
Zip: ,33 hod 9 Phone
- JVO
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY: Not Applicable
Name: NA
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, wails, 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 ari^ ah attornev before enmmpnrina wnrk nr rPr_nrdingr vnur bk-*ke of rnmmenrement_
u ° Si�gnaf, f'� - Wn L ee/Contractor as Agent for Owner
-w � -
Sign of Contractor License Holder
g /
STATE OF FII,,QQ R-�Dp
` "
STATE OF FLORIDA
COUNTY OF t`�! f, i
COUNTY OF
Swor o (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
_ ,Physical Preseapce �r Online Notarization
thi, day of -. x 2LI' � by
s
Rhysicai Prese ce r Online tanzation
this , day of 20 by
Name of person making statement.
Name of person making statement.
!✓
Personally Known OR Produced Identification
Personally Known `� OR Produced Identification
Type of ldenti cation
Produced 1� d (
Type of I tification
e� \ C ,! G
Produce
(Signature of Notary b ` ; R$ State of Florida
(Signature of Notary P
..., c IOn ZD 0 3b5
Commission GG 921454
Commission No. `' of �+� ` My Comm s Oct 21, 2023
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REVIEWS
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SUPERVISOR
PLANS
VEGETA lON
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MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
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DATE
RECEIVED
DATE
COMPLETED
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