HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE CON
Date:
1 i
v-TED FOR APPLICATION TO BE ACCEPTED _
Permit Numbe : aa1 "d
OCT 06
Building Permit Applicatio T. Lucie Count
i Y, Per
Planning and. Development Services I mitring
Building and Code Regulation Division Commercial Residential =�
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 40-1553 Fax: (772) 462-1578
- A J'"')1f' .
PERMIT APPLICATION FOR:
L�r
Site Plan Name: Block No.
Project Name:
oN I 'y al,-, Nko
W-� +7a(( wit', &L)e4
New Electrical Meter Second Electrical Meter C-1CA4ed-
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 I Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
(10
Cost of Construction: $ Utilities: _Sewer _Septic) Building Height:
a�xwµ`� .° % (�.'. �, �.. j � NF" ,� ' �'r �ra�; '•" } ���ayy„sn; � �,pu;�
• �7�4t7+�Yc 0 Lce � aM �i '. T+i k,r, �' o. +. Iy }, vFrl n:'1
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Name V--Cl4",
Name:
Company:"r ',;;,':
Address:
City:
Zip Code:
Phone No
E-Mail
State or County License
0
Address: dGt-I t'd E'QBJ(,V"tf A 1,e.
City: �`rl"�.tk- i, r� �" w State:
Zip Code: Fax:
Phone No '0-7 ' � $`'"1
�Cb -t
State:
Fax:
E-Mail: f r'(n(J ,SC,S brn (ITf1L� � CMQ i 1 - C.�)M
Fill in fee simple � itle Holder on next page ( if different
from the Owner listed above)
It 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.
i
i
r
o a
MORTGAGE COMPANY: Not
DESIGNER/ENGINEER: Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is -hereby made to obtain a permit to do the work and installation as indicated.
I certify that rio'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 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 CorrmencOrhent Must be'recorded in the,..public records of -St.
Lucie County nd posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorneybefore commencingwork or recordingour Notice of Commencement.
Applicable
Name:
Name:
Address:
Address:
City:
Zip: Phone
Stater
City:
Zip: ' Phone:
� State:
-
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
'Name:
Address:
Address:
_
City:
City:
Zip: Phone:
Zip: Phone:.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
.COUNTY OF
COUNTY OF
Sworn to (or affirmed) and subscribed' before me of
Sworn to (or affirmed) and subscribed before me of
'G Physical Presence or Online Notarization -
Physical Presence or Online Notarization
this ,�c day of <Sl:tr� , 20k�,, by
this day of , 20_ by
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
Produce�.0 d 'A- L.
Produced _
(Signature of Nota ubli
r: r „,• NAMg)EGIVENS
(Signature of Notary Public -State of Florida )
COMMISSION # GG 022023
I
Commission No.
qkk;Docember16,2020
Commission No. (Seal)
••'ifOR���PA: Bonded TtlN Notary Public Underwriters
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