HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: CAioC 2
RECEIVED
, :.. SEP.3'0 2020
Building Permit Application
Permitting Departm@hl
Planning and Development Services St. Lucie Count
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:
' O ' - D IMAOUE T L10 MCI TW;-
2
Address:.
-Property Tax ID#: ,�I �' �Q �• C�OrJIn ' ®(A • Q Lot No.
Site Plan Name: Block No.
.Project Name:
C�? TAILED Df�SC*` IPTION OF WORK;
S
2,C rc (G . Q)ILJX11-J
New Electrical Meter Second Electrical Meter
cONSTRucT ON INFO' NATION;
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 Constructi Sq. Ft. of First Floor:
Cost-of Construction: �v Utilities: _Sewer. Septic Building Height:
OWNER/LE=5S�SEE; CONTR CTOR;
Name r) 0i -e_s Name
Address: r CAI l W Company::.
City: State. Address:.� �.eQ _ ` -
Zip Code:3y Sl Fax: City: State:
Phone No. ��(o� �d a SGUt� Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
E
e of construction is 2500 or more,a RECORDED Notice of Commencement is required.
e of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
i
44
P gM L «UNS CT1Ca N LAW SN (J AT N:
DESIGNER/ENGINEER: _ of 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.
Signatu of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLOR 134 STATE OF FLORIDA
COUNTY OF s �Q,IE COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to (or affirmed)and subscribed before me of
Physical Pres rice or Online Notarization Physical_Presence or Online Notarization
this day of 20Z6 by 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 Identifotion Type of Identification
Produc Produced
(Sign�ture of No - (Signature of Notary Public-State of Florida)
KAREN S. N ELSEN
�2o =State of Florid NgqQ�ary Public
Commission No. _ = mission �d 207484 Commission No. (Seal) -
%;'�oFF� My Commission Expires
�nnna` June 12, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE -
RECEIVED
DATE
COMPLETED
Rev. 5/6/20