HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: % ). L' 4V Permit Number:
RECEIVED
e NOV 0 6 2020
Building Permit Application Permitting[)epa
St. Lucie Countm
r
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: :;5) e- e 4
PROPOSED IMPROVEMENT LOCATION:
Address: 1 d "l O E)r
Property Tax ID #: yZ� I I -' J 1Y -- 6 Da b QQQ " 7 Lot No.
Site Plan Name: blzt I l Ku ( erlr eP, Block No.
Project Name: k 1 A
"t
DETAILED DESCRIPTION OF WORK:
+C % w 116 n-ew. v ,.
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
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
Total Sq. Ft of Construction: l ,,L/S-.2 Sq. Ft. of First Floor: IY5a
Cost of Construction: $ 1500. 00 Utilities: —Sewer —Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name De bore
Name: P_dwwrd St1 t+6
Address: '%b q10 .S OCLaQr' Can i f Y09
Company: E. s1Yl,+h E(ec*k ►c,
City: J'eosen 6ea" . State: jEL
Address: 5a07 Oak land L a IFe G if
Zip Code: 3 -1 9 5 7 Fax:
City: F-t- Pierce State: FL
Phone No.
Zip Code: 35/g51 Fax:
Phone No (5-(o 1 ) y5 a - 8 // 7
E-Mail:
Fill in fee simple Title Holder on next page (if different
E-Mail e.,5milhser v
from the Owner listed above)
State or County License C
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION -
DESIGN ER/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: Yourfailure 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 vQur Notice of Commencement.
ILI
Signature of Owner/ Less a/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF S4 . (u r
COUNTY OF SV . LipiQ
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
0t Physical Presence or Online Notarization
this di day of pi a JQ r n inner . 2020 by
this &L'� day of W 0 q em in¢y 2020 by
rawacil sm tt- ,
Cdwn r8 SwA
Name of person making statement.
Name of person making statement.
Personally Known `L OR Produced Identification
Personally Known OR Produced Identification V
Type of Identification
Type of Identification
Produced pr, GC:
Produced I)f. LAC
4" U ,,,
I ki� A4,1A -.0 PfA. NnIAW 2"blir
(Signature of Notary Public- rilla�a Leon
ommission GG 230883
ign ture of Notary Public- St e o ldh4 Leon
71* 230693
immission
Expires 06120/2022
Commission No. � -3
off Expires 06/20/2022
No. Cl(, Z36 $ °"`11
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