HomeMy WebLinkAboutpermit app - LevyAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: L Ca
Permit Number:
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Building Permit Application
Planning and DevelopmentServices
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT
Address: -a33( 1 -
Commercial Residential
TION:
Property Tax ID #:3vL JOL of
Site Plan Name: fr f ,1t
Project Name:-7;� -e- '!J -LA c -
DETAILED DESCRIPTION OF WORK:
VA q6t(
DOD
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
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Lot No. 13
Block No.
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 i Roof Pitch
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction: $ S� G� , _ Utilities: —Sewer _Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Namecc,+t7--'L,, w,
Name:
Address: JJ
Company: �I' c fS
City: Jt sr �:�-cstate:F 6
Address: r
Zip Code�3101916 Fax:
City: State -4:1 --
Phone Na:` 2% - Sr i!
Zip Code3l X19 "7 Fax:
E -Mail:
_
Phone No 7°7 Z r% $ 7 -S -z;,5
Fill in fee simple Title Holder on next page (if different
E -Mail IM �� L ( a� � f 5 ') &,
from the Owner listed above)
State or County License 5 '� C- �.3 f
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 MEN LAW INFURMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY:
Name:
Address: Name:
City: Address:
State: City:
ziP Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: 4 -Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY.
Name:
Address:
City:
Zip: Phone:
of Applicable
State:
Not Applicable
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 before Commencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Halder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF. tilo��i COUNTY OF 4^,
Sworn to (or affirmed) and subscribed before me of SKprn to (or affirmed) and subscribed before me of
K_ Physical Presence or Online Notarization _ Physical Presence or Online Notarization
this Zb day of _Q 0 b;i;� 2020 by this .7-& day of C A) aZ;yr 2020 by
Name of person making statement_ Name of person making statement,
Personally Known --- OR Produced Identification
Type of Identification
Produced
(Signa re of Nbthry Pu i 5 jorida) JOSEpH BAOiNI
MY COMMISSION
Commission No. (WIRES:
QG2
Doodad Tfttrt Notary Pubk Ul
REVIEWS IFRONT I ZONING
COUNTER REVIEW
RECEIVER
BATE
COMPLET
Personally Known __Ig_ OR Produced Identification
Type of Identification
Produced
rebf NotarVPublic- i e,Q; .ipi a JOSEPH BADI
ion No. : SM_Y,GOMMISSlON # G
IRES:November
V g .'D gpnded Thm Notary Public
UPERVIS
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