HomeMy WebLinkAboutBuilding Permit Application.pdfAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 101rQ"q Ie40� Permit Number:
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:
PR PO
ED IMPROVEMENT,LOCATION
Address: (0-7
Property Ta
Site Plan Nz
Project Name:
as S. C2=n jam;
ID #: U 554 1 - 52 Q=1- GY.IU.•[p Lot No.
me: Block No.
DETAIL
D`:DESCRIPTI.O,N OF WORK;
New Electri
al Meter Second Electrical Meter
C7QN$TR
UCTION ,INFO.RMATION:
Additional ork to be performed under this permit -check all that apply:
_Mechnical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft Hof Construction: f e;c
Cost of Construction: $?,
Sq. Ft. of First Floor:
Windows/Doors Pond
Roof 949L Pitch
Utilities: —Sewer _ Septic Building Height:
OWNER
LESSEE:
---- -
CONTRACTOR:
Name
Name:
Address:Dr.Company:
City:�f'l n D=13 StateFL..
Address: .
Zip Code:',i Fax:
City: Jc__&7elStater
Phone Noj
Zip Code: Fax:
E-Mail:
Phone NO b-oW3- 1.225:
Fill in fee$imple Title Holder on next page (if different
E-Mail
from the i wner listed above )
State or Count License
Y
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.
SUPPLE ENTAIL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNE
Name:
Address:
City:
Zip:
/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
e:
I Phone
FEE SIMP�E
Name:
Address:
City:
Zip:
TITLE H ER: Not Applicable
I
BONDING COMPAN • Not Applicable
Name:
Address:
City:
I
I Phone:
I
Zip: Phone:
OWNER/ ONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that o work or installation has commenced prior to the issuance of a permit.
St. Lucie Cou
which is in cc
structure. PIE
In consideral
in accordanc
The following
accessory str
WARNING
impro%
Lucie C
with le
t�yy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
if ict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
!se consult with your Home Owners Association and review your deed for any restrictions which may apply.
m of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
building permit applications are exempt from undergoing a full concurrency review: room additions,
ctures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
'O OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
.ments to your property. A Notice of Commencement must be recorded in the public records of St.
,unty and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
der or an attornev before commencine work or recording your Notice of Commencement.
Signat a of Owner/ s ractor as Agent for Owner
Signature of Contract / ' ns der
STATE OF FLORIDA
%�1
STATE OF FLORIDA
COUNTY OF
COUNTY OF n
Sworn to (or affirmed) and subscribed before me of
Sworp to (or affirmed) and subscribed before me of
V Physical Presence r Online Notarization
V Physical Presence or Online Notarization
this dgay of 2020 by
this day of , . - , 2020 by
Name of p6rs n making statement.
Name of person m rn ,
p+l�•, T MA W. STEVENS
Personally now • t . !cation
�� #
_'•'•"•y" '" THOMAS W. STEVENS
Personally Known ]i�'l@@ fixation
V V V 11
Type of Id tific i x , ; Expires October 9, 2023
Type of Identificat Expires October 9, 2023
••�:" *' R,sri�l ituuTrny !u In�wuur n 8qp-1$5
Produced :•,r c;••°' n FeG�lt►suruuu�Nt?(f•a8�••llll'r
Produced 7019
4C'Ztt-.a
(Signature f Notary Public- State of Florida)
(Signature of Notary Pu of Florida )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev. S/6/2U