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HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: n I2 /20 Permit Number: ®I ©00 RECEIVED NOV 0 2 1010 o u nrfnitting Department - == Building Permit Application gt.LudeCounty 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: pe,.. ,a ," �ID #S 3�Z- lB�� `- 3 - C9O0 - 3 Lot No. Site Plan Name: Block No. 95 Project Name: New Electrical Meter Second Electrical Meter 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 o-tot • ;� ;085 o t r e I E8. Sq. Ft. of First Floor: 9—pt N ru`@155W—-V%4C07,C7-O Utilities: _Sewer _Septic Building Height: OUI/NER%LS�SEE A� C®NTRACi®R: f� Name L . Name: Address: (o60 t? -r4 CJ6964> -DP. Company: City:T. ��nC State: Address: Zip Code: 'a-Qi3Z Fax: City: State: Phone No. 77 2 52�,2(c Zip Code: Fax: E-Mail:�l(��E1:5 5l,<0SJM4yL Phone No Fill in fee simple Title: Holder on next page ( if different E-Mail from the Owner listed above) State or County License If value of construction is 2S00 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. SUPPLEM�ENTAL�O�ONSfT ''U, OFIkON r LIEN LAW INaFOR1MATION Y DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable Name: Name: Address: Address: City: City: Zip: Phone: Zip: Phone: 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 commencing work or recording vour Notice of Commencement. Signature of Contractor/License Holder Signature of Owner/Lessee/Contractor as Agent for Owner STATE OF FLORIDA STATE OF FLORIDA , COUNTY OFF �, • l�1��/� COUNTY OF Sworn to (or affirmed) and subscribed before me of ✓. Sworn to (or affirmed) and subscribed before me of Physical Presenck or Online Notarization Physical Presence or Online Notarization . this ,;/— day of 2020 by t�f\IINACAL Vevel� this day of , 2020 by Name o person making statement: Name of person making statement. Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identi on Type of Identification Produced Produced (Sigr-AtlKe of qi ` ,f'1�blic PVJ9 LSEN (Signature of Notary Public- State of Florida ) =State of Florida -Notary Public Commission ;; o. Commission # gSWY484 Commission No. (Seal) %,pF7 mission Expires June 12, 2022 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.