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HomeMy WebLinkAboutBuilding permit Applicationt.-f ) , r 7" All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1 Date: Permit Number:AOI®'O%s 94,40# R�'"' Building Permit Application Planning and Development Services Building and Code Regulation Division Commercial 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 PERMIT APPLICATION FOR: Residential Address: S511160 PropertyTaxlD#:�3�2���'© Site Plan Name: - Project Name: New Electrical Meter i` o Second Electrical Meter 40 Additional work to be performed under this permit=check all that apply: _Mechanical Gas Tank —Gas Piping _ Shutters _ Windows%Doors Electric -.11"P'lumbing _Sprinklers _Generator _Roof' T6tal-Sq. Ft of Construction: Cost of Construction: Sq, Ft. of First Floor: Lot No. Block No. Utilities: _Sewer _ Septic Building Height: Pond Pitch OR/LESSEgE=�°Y�� "'"r" i,L FCONTR§ACT®R r �> A Name Ri'40 C� u--v- GR Name: SMA Address: sP%y!cS N "P3V&-9'D Company: Address: City: i'T State: tLA Zip Code: 3<1C4G� i Fax: Phone No. 16 d °a© R' 1;oq IF y%lap Q�YAtbo.c13m Fill in fee simple Title Holder on next page ( if different from the Owner listed above) City: State: Zip Code: Fax: Phone No E-Mail State or County License If value of construction is 2500 or more, a RECORDED Notice or commencement is requires. If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required. TI(J`N, �;`• MORTGAGE COMPANY: Name: Address: City: Zip: Phone: - , ` Not Applicable State: DESIGNER/ENGINEER: Not Applicable Name: Address: City: State: Zip: Phone FEE SIMPLE TITLE HOLDER: _Not Applicable Name: BONDING COMPANY: _Not Name: Applicable 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, fen ces,_walls,-siggi , ss reen 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 wit lender or an attorneybefore commencingwork or rec in our Notice of Commencement. ev. 5/6/20 p Wignature 4ignature of Owner/ ssee/Contractor as Agent for Owner of ntrac r/License Holder STATE OF FLORIDA n/► Il(J'y� STATE OF FLORID �(y� COUNTY OF Ly, «^• COUNTY OF ktirll'lA,/� c Sworn to (or affirmed) and subscribed before me of l/�hysical Online Notarization Sworn to or affirmed) and subscribed before me of �ical Presence or Online Notarization Presence or this � day of1f Ot�k�y/w'' , 2020 by this ZI day off (9��+�i' , 2020 by � lh/IW�rJI SJ�1 KQ�✓ l"N'�A.DI� S•� � �"G� Name of person making statement. Name of person making statement. Personally Known OR Produced Identification ✓ Personal) Known 1:i%cat' `� Y Identifi ion MATT MARTISE Type of deritificationel/n Type � ; pG � Public, State of Florid Pr ed Q�- � Produc � :Not,"ry = Commission# HH 6154 ALJk comm. expires June 2, 202 re otary Public- Sta re of Notary Public- State of Florid'a,) �" v A G(S o" MATT MARTIS 11 •`