HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED. .
Date: J! I Permit Number:��l/Q Q SoQ
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RECEIVED
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Building-Permit Application
SEP.2 3 2020
Planning and'DevelopmentSe (rces Permitting DeRa�nt
►t� St. ie C tv
Building and Code RegulationDlvtslon Commercial ResidentialLuc
2300 Nlrginla Avenue,Fort Pierce FL 34982
Phone:(772)462-1553,Fax:I(712)462-1578
PERMIT APPLICATION 'rOR:
PROPOSED-IMPROVEMENT LOCATION:
Address: N,6 - .
Property Tax lly#: Lot No.
Site Plan Name: - Block No.
Project Name: 12`VrP , 4t
DETAILED,.DESCRIPTIO�-OF WORK:
_���►°0�£ �� (,fcJ����`—.rjS`:�4L, ./1��`�'7i�1'i/�5��'� �rt6i U�eTld lolerl� �'�E�T
4(-/0,1 6%PiuyAd 0
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New Electrical Meter Second Electrical-Meter
CONSTRUCTION INFORMATION: -
Additional work to be perfor ed under this permit—check all that apply:
Mechanical _Gas Tank Gas Piping Shutters _Windows/.Doors _Pond
_Electric _Plu Bing _ Sprinklers . ` ^Generator Roof Pitch.
Totai-Sq.Ft of Construction: Sq.Ft.of First•Floor:
Cost of Construction:$ .5,bo0 Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR.
Name S Name: „�a c.d1 I �i GGo i 3�
Address: _; 2Am 41kZ014 b9 Company: �i cGJ 5r FVZ`!S gca T j
City: State: ,, Address: 12;R rj&< X)Es i f�
Zip Code:' �95� Fax: "Clty; __ ST/uz State:fit.
Phone No. k? f Zip Code:` Z Fax:
N 2� r.-ate 4-
E-Mail: Phone o 3
Fill in fee simple Title Holder on next page(if different E-Mail _5 p i, i a J l y-,
from the Owner listed above) State or County License ?�7
If value of-construction is 2500 of more,a.RECORDS Notice of Commencement is required.
If value of HAVC is$7,500 or more,a RECORDED No ice of Commencement is required.
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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: i
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the,6ork 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 ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or an covenantst at may restrict or prohibit such
structure.Please consult with your Home Owners Association-and review your deed for any restri tions which may apply.
in consideration of the granting of this requested permit,I do hereby agree that I will,in all respec is,perform the work
In accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendme its.
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 an 3ther.non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may resultI in paying twice for
improvements to your property.A Notice of Commencement must be recordd 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 Noticelof Commencement.
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Signature of Owner/Lessee/Co tractor as Agent for Owner Signature of Contractor/License Holder
STATE OF.FLORIDA / STATE OF FLORIDA
COUNTY OF S4. COUNTY OF
Sm or fo(or affirmed)and subscribed before me of Sworn to affirmed)and subscribed before me of
P�11tt��jjcal Pre nce or Online rization si res ce or I Online Notarization
this Oj=of 20 y this a of 2 2CL-bby
D /,/ 1111L ") e'; &'t
Name of person making statement. Name of person making statejnent.
Personally Known OR Produced Identification y Personally Known O 1 Produced identification
Type of Identif on Type of Ident'f atio
Prod i Mae& Produced L—
Sign a of Notary P to--State of Flor' } (Slg6atdire of Nota is
p Ao � ETTE RODRIGUEZ
Commission No. 0 0�0' ( a LYNETTE RooRI Sion No. °� Public,State Of IGFlori
c Notary Public,State Florida commissionar GG 287
429
co xpires n.1,202
MY wmm.ex Tres jai.1,
REVIEWS FRONT ZONI VEGETATION SEA TURTLE
COUNTER REVIEW REVIEW R REVIEW REVIEW REVIEW
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