HomeMy WebLinkAboutbuilding permitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
y 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) 462-1578
PERMIT APPLICATION FOR: �G `r-
PROPOSED IMPROVEMENT LOCATION:
Address: 2- 'S Q %
Property Tax 1D fl: o o — Lot No.
Block No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter 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
k/Electric — Plumbing _ Sprinklers ! Generator ` Roof
Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
f rfr"rri.,.,• c 5J+,,, Utilities: _ Sewer _Septic Building Height:
CONTRACTOR:
Name: L m ''`N
Company:
Address: �2 u "� L 1
City: `e r- G � State: r o
Zip Code: 3 I _ Fax:
Phone No
OWNER/LESSEE:
Name�Ryce yA, Vhi Mtn c
Address: 'Z5-0? LE,ts rt2�)=�t Qr
City: r'? Stater L
Zip Code: �" Srd `Z Fax:
Phone No.7 72- qL1 3 q el
E-Mail:
E-Mail �►� �l 1 SC r✓i « (rmrl r��°n
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County LicenseEO 3 b R 48-12
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name
Address:
City' Phone_
Zip:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City: Phone:_
Zip:�—
Not Applicable
State:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:_
Address:
City:_
Zip:
Phone:
Not Applicable
tate:
riot Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that nooty work or installation has commenced prior to the issuance of a permit.
makes no ure
wthtch is In� onfiict with any applieablerHomeon aOlwners Asgoctat ontru esill abyl ws oruthorize tandhe pcovenantermit ds thaer � may restr toot prop bit 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 pe7ore LVFT11T1tF1L1 fig WUrK ur Ft!L rrwn vur IV ULMC vI %.. lI Ii�i�i
/ fl
LI)
Signature of wner/ Lessee/Contractor as Agent for Owner Signature of Cont actor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF si . Luke COUNTY OF SA - I_t,1(l2
Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
X Physical Presence or Online Notarization .L Physical Presence or Online Notarization
this p day of (�c- c) tr 202D by this -7� day of _n6 o b cLC 2020 by
�u d r) $m.J_Erb u�aVd SM d
Name of person making statement. Name of person making statement.
Personally Known
Type of Identification
Produced Piy, U
ature of Notary Publ
OR Produced Identification
r+ A — trvtary PvDiic State of Florida
Mona Leon
y d My Commotion GG 210897
Commission No. Z,� (Seal)
REVIEWS FRONT ZONING
COUNrER REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 5/6/20
Personally Known OR Produced Identification
Type of Identification
Produced 00,
wctan P'-cm, State of Fonda
¢ n
(Sign)Lure o PU4-
30,5aryPubii t o Fhaon cG zaa 't
h n Exp res 0&2a'Z02: <
Commission No.,,,�,�,t�rw
SUPERVISOR
I PLANS REVIEW I VEGETATION EV EWS REVIEW LE I MANGROVE REVIEW
3- Zoo l4c_
Nt,.,)
�t1 So��P C.J
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