HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
`T, LUCLL
" t` Lt�� 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: 1 �)S'a\ IU)s
Property Tax ID #: - — V 0U (D _ Lot No.
Site Plan Name: (- O ( A_ Block No.
Project Name: hol�U4_�V)Acmk
DETAILED DESCRIPTION OF WORK:
�S
0
New Electrical Meter Second Electrical Meter
[CONSTRUCTION INFORMATION:
k
Add iIional 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 Construction:
Sq.
Ft. of First Floor:
Cost of Construction: $ (
(' �� C a
k �
t
Utilities:
—Sewer —Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name A2
Name: o -n — I C 1�
Address: 3 S
Company: C
City: :� ko�( ko e State: _C�_
Zip Code: Fax:
Phone No. 07)—
Address: Y10 U
City: State:
Zip Code: _333c -� Fax:
Phone No P SL1` v,� s' S-1-t CA
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail ' 4 `
State or County License �&os:3
IT Value oT construction Is lSUU 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.
SUPKEMENTAL, CONSTRU0,0 JE 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 4nflure to Record a Notice of Commencement may res t in paying twice for
improvements to your p operty. A Notice of Commencement must be rec p(rded in the public records of St.
Lucie County and post on the jobsite before the first inspection. If yo tend to obtain financing, consult
with lender or a nev before commencine work or recording vourMobce of Commencement.
Signature of (J ner/`Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF 1 L J
Sworn to (or affirmed) and subscribed before me of
�P ysical Prespricy or Online Notarization
this +' ) day of 0 An W7 2020 by
Name of person making statement
OR Produced Identification
ifi
ignature(oWVtary Pu
N,.
Commission No.
REVIEWS TER ROENING
DATE
RECEIVED
DATE
COMPLETED
Signp>x(e of Contractor/License Holder
STATE OF FL ID
COUNTY OF 0--),qr
Sworn to (or affirmed) and subscribed before me of
Physical Pres c or ine Notarization
this � day of 2020 by
5) �kle,yt � Ci�tri_H 4 r
Name of person making statement. IWL
Type of,ldentification
IS' nat&-A
�A,
Corr ;s]_ •_vaY°'
OR Prod Identifkation
da )
(Seal)
SUPERVISOR PLANS I VEGETATION I SEA TURTLE MANGROVE
REVIEW I REVIEW REVIEW REVIEW REVIEW