HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: /o :�451�
REc
ST. LUCIE
F Lr'
OCT % S 2010
Building Permit Application Perstt"9cc u"ent
P
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial
Residential
PERM ITAPPLICATION FOR:
}._� t it r✓Y 1 V 1+r f `, 1 tf 5 U "1S 2 'krM'<F� 7 t
PRQPOSED`'1fUIPR01%EMENT LOCATION Y
tddress: M e & 411,erjU42
Property Tax ID #: _ 3®`F®rs�� C�6 Lot No.
Site Plan Name: F� L ll\ o+ 1 119✓►(� j7(�T-%f(c�f Block No.
Project Name:_ _RL,VMYeJ0y4 Rod Olt,,y
New Electrical Meter Second Electrical Meter
i 1e •C -yi r! .f K'4 ,. I -i. z ( ,tt t v Hr Sxdslr
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:.CONSTRUCTLON FI NtFOrRIVIATI®�N ! 'R 4t;ttrM r ,�
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: Sq. Ft.. --of First Floor:
Cost of Construction: $ o® ,.Ce� Utilities: Sewer _ Septic Building Height:
. >> lW,\ �,
G-�ON;ER/LSSErE
^ CONTRACTOR:`
Ott
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Name V-1 010 D1 d r"y�s
N-ame:'
Address: . /'Uc � C
& ,�C J'Company:
City: %~C9,lie-ec'c-e— State: '
Address:
_
Zip Code: 3L16L'*"'_' Fax:
City: Stater
Phone No. 2 9' % p 7
Zip Code: Fax:
Phone No
E-Mail
E-Mail: I CL00
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
-.. _ . -----
State or County License
nr= WF%ur,J tYUL1cC u1 %.ummencemeni is requirea.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required. r
DESIGNER/ENGINEER: _ Not Applicable
Name:_
Address:
City: _
Zip:
Phon
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
rite•
Zip: Phone:_
M& TGAGE COMPANY: Not Applicable
Name;
Address:
City: State: _
Zip; Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
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. Pleafsle consult n 1th your Home Owners Association andreviewdeed for any restrithat
t o s which m y apply obit 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
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.
Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OCOUNTY OF
Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
r✓Physical Presence or Online Notarization Physical Presence or Online Notarization
2020 b this day of 2020 by
this day of 1,1i� y
Name of person making statement. _ I Name of person making statement.
Personally Known OR Produced Id
log Iooni
1 ID
Type of Identificatio 7 N
CC � - MN
Produced O cow N
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Signature of Notary Publ' - State of -Florida )
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( Seal
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Commission No.
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FRONT
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REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
PLANS REVIEW I VREVIEWON I S REV EWLE' MREVIEWVE