HomeMy WebLinkAboutBuilding Permit Applicatione
IN
Ail APPLI CABLE iNFOMUST BE COMI ,: "ED FOR APPLICATION TO BE ACCEPTED r
Permit Number:
Date:
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Q 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:
Address:
Property Tax ID #: - 5lJ G " d b G - Lot No.
Site Plan Name: Ga/ ,Q Block No.
Project Name:�l
New Electrical Meter Second Electrical Meter
CQNSTRUGTI'ON.-IrINFORMATlO'N
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _-Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers
Total. Sq. Ft of Construction:
Cost of Construction: $ (06 00
_ Generator
_Windows/Doors _ Pond
Sq. Ft. of First Floor:
Roof Pitch
Utilities: —Sewer _Septic Building Height:
OUVNER/LESSEE `
CONTRACTOR"
Name 13 tf plhrm-&Name:
r L lG "00IC
Address: & C 6
Company: /s Jue
City: Y mr— 1 State: P/
Address: Slv k'
Zip Code: 3 (IC15 Fax:
City: P
OiYLOAAL1 State: P
Phone No. 0f
zip Code: 35b b1l Fax: g5Y{ -V)'-oyys
E-Mail:_ _oil a ( &* Q
Phone No 800- AAA-(o(o`77
Fill in fee simple Title Holder on next page (if different
E-Mail MitXG aP& t'\ & a-WL S0 ff4( 'C6Wk
-from the Owner -listed above)
State or County License 66 C i 5o 7a,
72
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.
Nam
City:
Zip:,
�NS'TRL I' LIEN LAW INFORMATION:
tc _Not Applicable MORTGAGE COMPANY: Not Applicable
GAShouse, Name:
Address h G-- State.
State: r-/ City:
one a� - Zip: _ Phone•
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name,
-
Address: h w
City:
Zip: Phone:
BONDING COMPANY:: Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR.AFFIDVIT: Application. is hereby made to obtain a permit to,do the work and installatiori 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.ccvenants that may restrict ap
ply.
such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may a I .
In consideration of thegrantingof 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 toyour-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 recordinta vour Notice of Commencement.
Sig ture of Owner/Lessee/Contractor as Agent for Owner
Signature of Contractor/Lice se Holde
STATE OF FLORIDA
Sf LU.Ct
STATE OF FLORIDA
OF draw d
COUNTY OF a
COUNTY
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Presence or Online Notarization
this day of 2020 by
this a( day of DG�_ , 2020 by
(Aw rage- u. cickanor icy ,
_Name of person making statement.
Name of person making statement.
Personally Known '� OR Produced Identification
Personally Known. ✓ OR Produced Identification
Type of Identification -
Type of Identification -
du ed
Praduced
N ie State of Florida
F to o/Florida
(Signature of N ry b t e y m s�i�n GG 3z2ses
yq
(Signature of N ary P litl o�xpires o5i0510
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°"` /2023 322569
Expires OS/05/2023
•OIK
Commission No.
Commission No.
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KeV. 5/0JZU