HomeMy WebLinkAboutBuilding Permit Application 6�-
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED .
Date: } Permit Number:
d�`-JFCE,LE!,-,
Building Permit'Application AUG 1 9 20110
Planning and Development Services'
{ le l ou , Permitting
Building and Code Regulation Division Commercial Resi
2300 Virginia Avenue;Fort Pierce FL 34982
Phone:(772) 462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:.
Address: 1
Property Tax ID'#: O 01 U/A=OWIE Lot No.
Site Plan Name: Block No.
Project Name:
DETAIL D [OMMOMM @F mom
w ' - 2-Azte
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMA ION:
Additional work to be performed under this permit-check all that apply:., '
_Mechanical -Gas Tank -Gas Piping _Shutters Windlows/Doors ` _Pond
Electric _Plumbing _ �Sprinklers _Generator _'Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ ����� llfiI if"es: Sewer,: Septic Building Height:
OWNERfiLE�S�SEE: CONTRACTOR:
Name �s 4.mot s»V-4r �3 ;jF 1pV .Name: ..
Address: '!10 Company:
City: z e4le State: �M' Address:
Zip Code: cL'4 ' fax: City: State:
Phone No. Zip Code: . Fax:
E-Mail: d^ s 1,6- �`T��i ne No .
Fill in fee simple Title Holder on next page (if different E-Mail_
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
If value of HA:VC is$7,500 or more,a RECORDED.Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY- of Applicable
Name: Name:
Address: Address: a
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: of 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.
Signatur Owner/ I ignature of Contractor/License Holder
STATE OF FLOR D STATE OF FLORIDA
COUNTY OF COUNTY OF
Savor o(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Ph slcal Pre nce or Online Notarization Physical Presence or Online Notarization
this-day of 2020 by this day of 2020 by
Name of i1erson makin t�atement. Name of person making statement.
Personally Known ✓ OR Produced Identification Personally Known OR Produced Identification
Type of Ide ific 'on Identification
;;;acre,•., KAREND.SI(vIMONS
Produced `,= Commission#GG30a2�}5 Produ d
-k;
.rC : Expires July 5,2023
°r' Bonded Thru Tro Fain In 0-3 -
(Signat Notary Plic-St/a� ure of Notary Public-State of Florida)
Commission Now ry 3CM45 (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW- REVIEW
DATE
RECEIVED
DATE
COMPLETED
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