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HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: 01'T ��) (�[][ RECEIVED Building Permit Application rtment Planning and Development Services Building and Code Regulation Division 92nr1 1/irninin dvonuo Pnrt Piorro P1 UPR7 Commercial perm! ti Depa St ucie County Residential Property Tax ID #: _ `� �� - (� 40 ® 0 > • Lot No. Site Plan Name: Block No. 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 Electric _ Plumbing _ Sprinklers _ Generator Total Sq. Ft of Construction: Cost of Construction: $ _ Windows/Doors _ Pond Sq. Ft. of First Floor: Roof Pitch Utilities: _Sewer _Septic Building Height: ?1 9?i�-°`d' `$'Tf.�` b,' 'k."�d:Y�1��>3'�'.4Y-.w:3ER9d .�.•. �Y�(,L3�, W:f� Y 5 ht i • :!i `�' ^�.'t �' " �' rNA rr^-T '.✓�'4YPos,lth"`Y. 'Tii .R'titi -ice :I T��.. � r'n-`i +Z� 5"2E1,,.. _ ...�IIi k � S t .L Name Name: �f~ Addres : / a If ee okv Company: liG '� City: efcei Zip Code. Phone No. State: Fax: Addr City. / Zip Code: Fax: Phone N State: E-Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) E-Mail Pill S %©6 lea' State or Cou ty License a 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. M w DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: _ N t 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 Ipnripr nr an attnrnPv hpforp rnmmencinp work or rseandiniz vour N-etce of Commencement. ture of Own / ssee/Co trac as Agent for Owner ZAT S' nature o Contr ctor/Lice e H d r E OF FL RIDA STATE OF D COUNTY OF COUNTY OF Swor to (or affirmed) and subscribed before me of Swo n to (or affirmed) and subscribed before me of Physical Presence or Online Notarization Physical Presence or Online Notarization this _(O� day of N r V 2020 by this -4o- day of 0\1 V- U • 12020 by Name of pers9fi making statem n . Name of per on making sta ment. / Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of identification Produced Produced (Signature of Nota ublic- State of Florida) (Signature of No y Public- State of Florida ) Commi AUDREY B. HUMPHRE(Seal) Comm'slo�r�j g�,r nirnocvR uii` PHREY e ) :,- MY COMMISSION if GG 300817 = _°' ' ' "4° =. �i MY COMMISSION f# GG 3008'17 EXPIRES: March 6 2623 Bonded Thru Not 'Y Public Undermi:ers `� ! ' � "s ' Q ` L . OF FLU.` r hi i r iS MANGROVE 'FR �MNF1V ''SUPERVISOR REVIEW" PLAN".,.n,,q, COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.