HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE(INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: lI-td ''C)_V Ck0 Permit Number:
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' Building Permit Application
Planning and Development Services /
Building and Code Regulation Division Commercial Residential V
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR: e-
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Address: C2to
Property Tax ID#: � '� �d Lot No.
Site Plan Name: Block No.
Project Name:
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New Electrical Meter _Second Electrical Meter
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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 CJoL Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: _Sewer _Septic Building Height:
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DOWNER/LESSEE >t� F_; r�,r ! v ,fix= �CONTRACTOiR
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Name�'lh:�� /�c��2ir���� Name: t. C)"
Address:oCkC7<� e�c,�te�►��i�cn f��1� Company: -7cre: n -I `+ f �.
City:_� Ne-fC t - State:l� Address: t .� (40(.T L 10
ZipCode: ��(�(�1 �0 Fax: City: C 1
(, �c�f^'�'�)�:��iv�l.� (.aulCt� State:
Phone No. _r73-S 73- a7c) I� Zip Code: C b 3 Fax:
E-Mail: 13 cAnn 04We-' � CC)Or\ Phone No ��L� — ,57, / � �
Fill in fee simple Title Holder on next page (if different E-Mail Ll - QcP inn l i� ��C�F ir— (A`!9 ;(�
from the Owner listed above) State or County License
U 69
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.
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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 inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording-,your Noti , of Con)Mencement.
G.,-Tignature of Owner/lessee/Coneactor as Agent for Owner dig ure of Contraetor/Lic n;e er
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S -r. i. )c%-e COUNTY OF S)r \_%j
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed) and subscribed before me of
Physical Presence or Online Notarization Physical Presence or Online Notarization
this NA 'day of V)aJ 2020 by this 1 day of tJ o- 2020 by
`3�e 0. P.-bCtil•�;S Sw.-��� v\ -LdJ-. 5 1,
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary blic-State NS (Signature of Not "
IE GNE �i s�Y���• IE GIVENS
UEANNAW GG022023 •• COMMIS I N# 022023
Commission No. P_ka• .•, 1k COMMA"21 t16 2020 Commission Ni . 60Ks PIRES: 16,202D
dedlTh NotazY nbitc Undamotera °'soF tqa t Bonded Thru Notary Public Underwriters
REVIEWS ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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