HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10 - 1 _l " z®Z0 Permit Nu
SM. WCEIS O C T 20 2'020 I
Pn"'I"w;
�a� 'r .ST. Lucie County, Permitting
Building Permit Applica —
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: Shims , L q�- A �
Address:
Property Tax ID #
Site Plan Name:
Project Name:
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\j3%\\ S14- dt') UNCcreLe- Zlocks"
New Electrical Meter D11 A Second Electrical Meter 4v A
34
Lot No. ZLA
Block No. 3ILD
Additional work to be performed under this permit -check all that apply:
—Mechanical Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
T Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: 1`
Cost of Construction: $ �`, Oa
Name l_ SV—
Address:460(n 190LaAiWApJ T>0\JE
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
City: 1-1 i?Mgs , State: A_
Zip Code: 3y 61 %Z Fax: ``,�14 A
Phone No.-)"72 - 3%6 " 03%-1
E-Mail: ►\\&&Wzen9 I A GMJUL 03M
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name:
Company:
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail
State or County License
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.
DESIGNER/ENGINEER: _ Not Applicable
Name: w -- C.1RS�01'3 _ ffi i eawe tic -
Address: Z o E►JiYA Cs b�
City: tate: FL
Zip: SZ- °i Phone Gy`? - S3°1 ^Z3SZ
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: Not Applicable BONDING COMPANY: XNot 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 attorney be a comn_Wncing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contra as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF N..0 c
COUNTY OF
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 ad day of 6 2020 by
this day of 2020 by
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
Produced 'Y—L.- tD L
Produced
(Signature of Notary Pu ic- State of Florid
(Signature of Notary Public- State of Florida )
pjpMpRIE GNEN3
Commission No. �' '�isf a GG022023
Commission No. (Seal)
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REVIEWS
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.