HomeMy WebLinkAboutCail Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:_
Permit Number:
�O
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: 5clra;h 9", ECmd0_1 I N61
f PROPOSED IMPROVEMENT LOCATION:
Address: -44M M A
Property Tax ID #:
Site Plan Name:
Project Name: _3cwall
DETAILED DESCRIPTION OF WORK:
4�
Lot No.
Block No.
ItV Qm4 -bn 14 Six 61,ta►y►
had Q Lf StAs+ w'lh i bo '�10 W(I _LCUM 01-a Do 14 Sits
��"UL ."/A W A Qu V l)m '�o '�, 1\�D DuCT tocx L
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Add it'onaI work to be performed under this permit- check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: 39(sr-)
Cost of Construction: $ 19 19 15 Q - CID
Generator
Sq. Ft. of First Floor:
Windows/Doors Pond
Roof Pitch
Utilities: _ Sewer _ Septic Building Height:
OWNERAESSEE:
-
CONTRACTOR:
a,,j1
Name, Gt11 i tl
Name: jll i N�CX (
AddressM54 A MA
Company:. 2' z", Aw 113Y11 }
City: I-il,I,fb ll 1) i'1 Ifsl (k l State: R.
Zip Code: ,341 Fax:
Phone No. 1�903- 40 I"- 3�lal
I�i
Address:t_IM5 E. C�JQOY CL1 �V1�' 11
City:-OIAWAW �IStGGate:V-h
Zip Code: ��R's'go Fax.4b I %c _ ,�,�bLp
Phone No Wa-9r10- 51153
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail 16 Sk1ii���f�YCI�[�ilYi(k�1Il� CUYY1
State or County License QAO09, 655
--------------•- ---.—...,,.,.,........IVWUw=v1�vnunenGefrle"JISrequirea.
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 TITLE HOLDER: _ Not 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 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 lender or an attorney before commencing work or recording our Notice of Commencement.
Signature of Owner/ Lesse ontractor as Agent for Owner Signature o ontractor ense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF D1() lq COUNTY OF i� YGI YIQ�,
Swoh to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
P�h�yysical Presence or Online Notarization V Ph1�s.,i�cal Presence or Online Notarization
this I l,�►"tday of W%byy 2020 by this day of 2020 by
Name of person making statement.
Personally Known f OR Produced Identification
Type of Identification
Produced
No.vpla A'
ignature of Notary "lic- State of Florida )
Commission N
Notary Public - State of Florida
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DATE
RECEIVED
DATE
COMPLETED
ev. 5/6/20
Name of person making statement.
Personally Known V OR Produced Identification
Type of Identification
Produced
Signature of Notary P b ic- State of Florida )
ComS(,''�0,, nueunn i irrLE
`�(�; Notary Public State of Florida
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