HomeMy WebLinkAboutbuilding permitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
IL
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) 462-1579
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
V/
Address: - 5 -1- I2- ?4� Lor" I-Plc-C' FL
Property Tax ID #: I? `-t D "Z (r. a _L - o-. 1% 3 0 v�;' O - 8 Lot No.(6
Site Plan Name: V, _r , - Block No. _
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter V Second Electrical Meter
CONSTRUCTION INFORMATION:
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:
Cost of Construction: $ Z 41 Sc-2 • o
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name P P h, )L E �i-\C Name: L)A(-� Vk
Address: 5-5-11 P1ire- fit` Company: ,. Sm, 4 r, act o7-l'.e-elj- S,Cr✓,C air it
City: �nt--%- State:r=C_ Address: 5 Z o-� Pp* V*Aru�o ►.-R h---t- GCc
Zip Code:-2,L-t a Fax: City: Fo rT rp -e rc_-r State: lG L
Phone No.%72"t175- dll 2 Zip Code: 3'-1 6 z- M_ Fax:
E-Mail: Phone No_5b t - K 5-�--- i`3 Ill
Fill in fee simple Title Holder on next page ( if different E-Mail rk L Tt rS' C('(l, Q �m �: �, �n�►,
from the Owner listed above) State or County License_(', C? 0 U q't W_3 _
it value or construction Is Z500 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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Address:
City.
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State
Not Applicable
MORTGAGE COMPANY
Name:
Address:
City:
Zip: Phone.
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
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
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 attornPv hPfore cnmmpnrinA wnrk nr rarnrdinP vntir Notice of Commencement.
Signature of wner Lessee/Contractor as Agent for Owner
Signature offContractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF �j Lt _t'Q
COUNTY OF Si , Luo i e
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
mot;✓ Physical Presence or Online Notarization
_y_ Physical Presence or Online Notarization
this.24a day of OC(o%Pr' 2020 by
th,iiss� (I, da\yofa4o6e)Q 2020 by
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Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification t�
Personally Known OR Produced Identification k
Type of Identification
Type of Identification
Produced t�tr. LI C
roduced D<< LA
Notary Pubhc State of Honda
Mona Leon
. Notary Puthc State of F-00a
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(Sig ature o otary Public tNXAor' pir] s oeiza2oz2
Sigt ature of Notary Public f zl" eo)nmlasio� GG 230893
or
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Commission No.
Commission No. Z3o(�Q 3
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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