HomeMy WebLinkAboutPermit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: - c J 1 Permit Number:
V L1P 1�,1�L�
0
Y ti Building Permit Application
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:
PROPOSED IMPROVEMENT LOCATION:
Address:
t)S9- 10-&/"r1 ')i
Property Tax ID#: C va vol - o(z--
Site Plan Name:
C-X-C. C' CC
Lot No.
Block No. l}
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
Mechanical
Electric
Gas Tank
Plumbing
Gas Piping
_, Sprinklers
_ Shutters
Generator
Windows/Doors Pond
Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. o First Floor:
Cost of Construction: `
$ ' G r Utilities: = Sewer — Septic Building Height:
OWNERAESSEE:
Name j h
Address: �A;>�acA
City: t %( c State. if—1
Zip Code: \3Lf 9 $ ")-- Fax:
Phone No. -- -
E-Mail:_,I
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name: T-+ t OLA, \ IC-c, i [,C ir.
Company: a
Address: �-i ' �-1-V- S V-e cl --
City: State:
Zip Code:LAC{� Lj Fax:
Phone No<�-q L3 C)
E-Mai aeL L-CLki,,"
State or County License 5 j
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 CONSTR
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
ON LIEN LAIN INFORMATION:
Wot Applicable MORTGAGE COMPANY:
Name:
Address:
State: City:
Zile Phone:
Not Applicable J BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that noworkor installation has commenced prior to the issuance of a permit.
St. Lucie Count
which is in conflic with aony applicableHome Oat wners Association onirulels authorize
or andpermit
covenants that malq the
tborr prohibits ch
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, f 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,
accessary 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 Nvtic omrnencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of ctor{License Holder
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of 2020 by
Name of person making statement.
Personally Known OR Produced identification
Type of Identification
Produced
STATE OF FLORIDA
COUNTY OF-
5 o to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day o€ OLA )bi—ii 2020 by
1ao i LN�A'n
Name of person making statement.
Personally Known -�OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public -State of Florida )
(Signature of N�ubfic-
Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Commission No.0 (13 9 1 -
fir ��fF
PLAINS VEGETATION SEA TURTLE
REVIEW REVIEW REVIEW
STACY RAU E
SON
)Tarp' Public-Sta e
f Florida
brnmission # C
913919
hey Gbmmissi n
xpires
�F3p[�rtelb9r 17,
023
MANGROVE
REVIEW