HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: '7. 2 - -v Permit Numbe�
S3Uo
JUN 2 9 2020
Building Permit Applicati
Planning and Development Services(. �9iC,i Ifs
Building and Code Regulation Division Commercial ✓ ResidentlaP ----- --- —
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 i
PERMIT APPLICATION FOR:
Address: is 10
F. F. (, 3Lt°I t
Property Tax ID #: ot31 ' S710 - V Uob " 000 - L4
Site Plan Name: L G c, ` vot ki rh; 5S;vti Co
Project Name: C IISri!✓ b1l1JLI.1
Lot No.
Block No.
C.Z i11•Pr'✓�i�• .. �
New Electrical Meter Second Electrical Meter
i. }NSTF1iJCT[# MiY I"IV
FORMAT IOW -
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 Construction: (p D 2 Sq. Ft. of First Floor:
Cost of Construction: $ C1 k 3 9. 2 Utilities: —Sewer _Septic Building Height: / 2
Name :f:� 1611 � c (3-U5 IVAVIS W; 0 0"1
Address: 000l bra►h C AV-eY'kf-
City: F. /. I i crce- State: FL
Zip Code: 34%l - Fax:
Phone No. Slot S 1"j - 5-15-1
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: IYt1VtA{ 1 JUhnsoil
Company: CA✓ 11,, carelyls
Address: IV? 12" d 1 ✓L
City: DobSvr State: N- C -
Zip Code: 91017 Fax:
Phone No 3362- 1<(P - 31'11
E-MailiLA4V1 • S Q CC -I- If 1517.
State or County License CSC 115
If value of construction is 2500 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.
R: _ Not Applicable
Name: 0 'Nl t - n
Address: OS 6
City: sw State: �G
Zip: '4102,61 Phone
FEE SIMPLE TITLE HOLDER: ✓ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: ✓Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: ;✓Not Applicable
Name:
Address:
City:
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 your Notice of Commencement.
Signature of
n ractor as Agent for Owner
Signature of Co ractor/License Holder
X0er1,_Lessee?e0-
a
STAT OF
COUNTY OF 'DeceA ✓
STATE OF
COUNTY OF'Dtc&4w✓
Swrn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or
Online Notarization
"" Physical Presence or Online Notarization
this *1 ?7 day of J^Ulne , 2020 by
this 23 day of _JVrie , 2020 by
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Name of person making statement
Name of person making statement.
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DATE
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