HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
ST. LUCIE
COU NT�Y ,-
F L ' O ""R
Building Permit Appl
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
MA
on OCT 2 0 2020
ST. Lucie County,Wmitting
Address: 3 6 0 1 14 1,vo(-n fZ) eitur A 3 5�"/ R/
Property Tax ID #: Z �12 O 01 d 0 5f ,r7 0 0 1 Lot No. / -3
Site Plan Name: ��wN Block No.
Project Name:
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New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
_ Electric _ Plumbing
� _ Sprinklers
Total Sq. Ft of Construction:'
Cost of Construction: $
_ Generator
Sq. Ft. of First Floor:
Windows/Doors
Roof
Utilities: —Sewer —Septic Building Height:
Pond
Pitch
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CO[UTRACaTOR?�x�.;,
.OWNER/,LESSE<Er
ry_ A'. .. r.. f�h`!t ,i:as_'.'3�5�.. 9:- �s1 �t ;s w.wt limo a...i7 f ✓�
Name. TN wk)
Name: v 6- o[..b )&/J
Address: .0/-g&&o
Company: PA V;i C-61 Pl✓ / 0 ! u !'G
City: i eRCG4 State: f Address:
04) o
Zip Code: _ 3 u°� Fax:
'City:;, Xle Gl _ State: -Cy -
Phone No. 117 1L- 5-7- Sy (07
Zip.Code:,.. 3 ✓� Fax:
E-Mail: 11OLt%/i% 43 Y9 R I/A400 a'[0!h
Phone No
E-Mail '►71�LlIt P PfiyA 60O ny 46A025 . C
Fill in fee simple Title Holder on next page ( if different
State or County License A& 17 J' 31 I �
from the Owner listed above)
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.
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DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: — Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: i hone:
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
structure. conflict
consult with your Hlome Owners AssoAssociation
ation and review your deed for any restrictions which maor
alprohibit such
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
improvemen o your property: A Notice of Commencement must be recorded in the public records of St.
Lucie Count�d posted on the jobsite before the first inspection. If you intend to obtain financing, consult
.. , _,...____ h Ir . i Utnrlr nr rarnMina vnur Nnfire of Commencement.
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Signature o caner/ Le ee/ ontractor as Agent for Owner
Signat of Contractor/Lice s Holder
STATE OF FLORIDA (
c�GCO
STATE OF FLORID
COUNTY OF '
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or aff, irmed) and subscribed before me of
Physical Presence qr� Online Notarization
Physical Presence or, Online Notarization
2020 by
this day of A�`r 2020 by
this day of Qii7�
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced N_ L_
Produced
(Signature of Notary P lic- State of Florida)
(Signat of Notarg Public- State of Florida
Commission No.<"6da-A-c 3 (Seal)
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