HomeMy WebLinkAboutBuilding permit app All APPLICABLE NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Application ST. Lucie County, perm)tting
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:r
PROPOSED IMPROVEMENT LOCATION:
Address: \V,'�J' -S 0 e'epill 'D_r
Property Tax ID#: 'A51D —��1 0��� � � 17C7—�, Lot No.
Site Plan Name: . r, i�g S@L.2 Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
V �4r \J rt
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: Sq. Ft. of First Floor:
Cost of Construction: $ 0---" Utilities: —Sewer —Septic Building Height:
OWNER LESSEE: CONTRACTOR:
Name " Name SV^
Address: Company:
City F- State: Q Addresss: 3u� S\Z V,�VVY A N `tad
Zip Code: C I Fax: City: 1lY$ SN VnLl\, State
Phone No. �� — \ / Zip Code:`�L_ k . Fax:
E-Mail:�L- S�� L Vvs. 1 l Phone No
Fill in fee simple Title Holder on next page(if different E-Mail ���.
from the Owner listed above) State or County License Cam\33W1
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:
DESIGNER/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: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 ink ectiyou intend to obtain financing, consult
with lender or an attorney before commencin or reco_`rt1h-Vyour17bticg of Commencement.
Si aatu Le ontrac r as Agent for Owner Si nature ntrac o e Holder
STA F FLO STAT FLOR
COUNTY L mac,�� COUNTY 0
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
V Physical Presence or Online Notarization -X Physical Presence or Online Notarization
this'a.\ day of 2020 by this ati day of se 2020 by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identifi tion Type of Identification
Produced roduced '�L
.. EANNAMWEGIVENS
^RAWAIQQW,�1 AM 22023
(Signature of Notary Public-State D NA 1 G 02202� (Signature o lic-19wasit5twidalp.2020
� 0 MISSION 16 2020 ;;„o?' Bonded ThntNotwY Public undenvdters
Commission No.q4C►� �S;OeCe etatltidecv l mmission
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REVIEWS FRONT NZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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RECEIVED
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