HomeMy WebLinkAboutBuilding Permit Application I
i
I
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
M,dumco
-
nn y ty6.,_
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:—IL_?9 S DC 6Ar`i �� f
Property Tax ID#: �15I 1 -S ZI -r)00( -o0o '
Lot No.
Site Plan Name: Block No.
Project Name:—lam lain/ C�tNi'_�4*A f
n l�P�nA��•� �
DETAILED DESCRIPTION OF WORK:
I
btJ-Wpn lttAJi L l r A��( / �.vs=VWrn2 1u 1A(, 1C:Mpoj2_A
ti- 2 �Jn/i1L- Nov csrv �� it' nN nV(
k
f
I
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION: -
Additional work to be performed under this permit-check all that apply:
Mechanical 'K Gas Tank X Gas Piping —Shutters Windows/Doors
_Pond
Electric _Plumbing _Sprinklers Generator Roof Pitch
Total Sq. Ft of Construction: N/ Sq. Ft, of First Floor: VA
I
Cost of Construction: $ l U y, Ucl 5f 00 Utilities: _Sewer _Septic Building Height: i
E
[Address:_
WNERAESSEE: CONTRACTOR;
i
ame 1���,nn„� P'Ly-r )PMeA�� -ro Name: Liaw to
9(;0'Z 5,4N Company: U2uj ��121clJ�
City;_ Q(Z �voa W I;C 32 fS1� State:_ Address: _2Z0 V(=mUS SY: ,_4: o
'
Zip Code: Fax:
City; �y-0tqe'ri State: t=t_
Phone No. Zip Code:_ S` Fax: 2G't-
E-Mail: Phone No G 26 C
Fill in fee simple Title Holder on next page(if different E-Mail +1 om
from the Owner fisted above) State or County License
!
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.
c
l
I
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: I
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
1
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
i
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 r d n the public records of St.
Lucie County and posted on the jobsite before the first inspection. If yot, end t obtain financing, consult
with lender or an attorneybefore commencingwork or recordingour Ice of C mmencement.
s
Sig atur of O ner/iLesseetC6htractor as Agent for Owner Signature o ontractor/Licens Holder
ST 4TEi OF FLORIDA STATE OF FLORIDA l
COUNTY OF C!'.�t.oy—)� COUNTY OF
Sworn to(or affirmed)and subscribed before me of Swbrn to(or affirmed)and subscribed before me of j
V Physical Presence or Online Notarization -Phvsical Pre nce o Online Notarization `
this day of 2020 by this day 2020 by
�711 s lvrLyaltta
Name of person making statement. Name of person ma� /king� tatement.
Personally Known !./ OR Produced Identification Personally Known y OR Produced Identification
Type of Identification ° Type of Identification
Produced , Produced
(Signature of Notary Public-State of Florida—) _ __ (Signature of Notary Pub ic-Stat
Commission No. :<�jrd�e•., r�PPb I A HERZ Commission No. .• '�F*! ar Public-State o Florida
Nota u b •State of Florida -
�� Commission#HH 000558 '-• Comrr,ission # H 57
tPr—M.Ex %v. My Commission Tres
onded through N Tonal Notary Assn. May 14, 20
REVIEWS FRO PLANS VEGETATION S
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
lev.5/6/20