HomeMy WebLinkAboutBuilding permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
�U-i 41D.
Planning and Development Services Building Permit Application
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 Commercial Residential
Phone: (772) 462-1553 Fax: (772) 462-1578
j PERMIT APPLICATION FOR;
R1%EM.fT
Address:
Property Tax ID #: '3L"- (-2-S 0 - 7
Lot No.
Site Plan Name:
Project Name: Mly- - "�fil An 1, 'n
Block No. `-t
New Electrical Meter Second Electrical Meter
Additipnal work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters — Windows/Doors Pond
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
Generator — Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
Name 2 S (,(-C
Address• �+ vt
City: �- State:
Zip Code: Fax.-7
Phone No. -
E-Mail: C C- C .ne�
Fill in feersimple Title Holder on next page ( if different
from the Owner listed above)
f value of constructinn Ic 7snn nr D[rnnMr . _. _
Name: \J-e (,h m9q/Y7( ri
Company: --')D56lr&nt7 cm
Addr ss:
City: 4.l State:�i
Zip Code: �� Fax: 7Z J'% -97Z7
Phone No 1'72 -3 01g --VT -
E-Mail " , ► -
State or ounty License�n-P-
----. - •---••_�•• ..+. i a.a�nn ncn(,CR1Cni IS requires.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
I DESIGNER/ENGINEER: re
Name; Not Applicable
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
— Not Applicable
MORTGAGE 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
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 attornev before commencine work or recording vour Notice of Commencement.
Si
r as Agent for Owner
/License Hol
STATE OF FLORIDAe-I STATE OF FLORID
COUNTY OF 1-T- �IG`� COUNTY OF
Swgt n to (or affirmed) and subscribed before me of
✓✓ Physical Presence or Online Notarization
this day of UL h±b4 , 2020 by
Je- Ae-;e�o V.
Name of persoWimaking/statement.
Personally Known J OR Produced Identification
Type of Identification
Produced
swoyn to (or affirmed) and subscribed before me of
✓ Physical Pres nce or Online Notarization
this Z day of U2020 by
(c,
Name of pers n making statement.
Personally Known V OR Produced Identification
Type of Identification
Produced
(Signature of Notary Publi
(Signature of Notary Publi
�y� Notary Pubic State of Florida
' A
e.. Notary Pubic State of Flonda
Commission No.
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