HomeMy WebLinkAboutBuilding Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ��� �0� Permit Number:
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:
Address: t"('P') y
t4
Property Tax ID #: 2-L-115 r -&LI -•[jMU - Ptb "T Lot No.
Site Plan Name: Ol'S , C tC9k'K Block No.
Project Name: M0-\'
New Electrical Meter Second Electrical Meter
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 Constructio: n
Cost of Construction: $ `{3-39
Sq. Ft. of First Floor:
Utilities: —Sewer _ Septic Building Height:
Name (!Y-,ark-f\P_ la r7yr6We..
Address:
City: �c f k P cV_f cr- State: L-
Zip Code: 3 k}°(g Z Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: ( r,.2m4' &Mi`
Company: r Oo �' ^A a
Address: '$ 36 AY'6fC A
City: �b`f A,- PkC_Q_C_ State:_
Zip Code: Q 0( Fax:
Phone No "772. 1� S Z ro 7
E-Mail ''rv.CQ'V ki ^I
State or County License O
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.
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
City:
Zip: Phone
_State:
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 j
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 NER: Your failure to Record a Notice of Commencement may result in paying twice for
improv en to your property. A Notice of Commencement s be recorded in the public records of St.
Lucie unty and post on the jobsite before the first inspe ion. I you intend to obtain financing, consult
wit ender r an a ne befor in work or rec din our Ni of encement.
/r
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wne essee/Contractor as Agent for Owner
nat�r7!0�
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Si nat r/License Holder
E F FL DA
LINTY OF l �Q
STATE OF XFLIDAA
(�C.1i
COUNTY O
Sww�o (or affirmed) and subscribed before me of
Swo to (or affirmed) and subscribed before me of
Ph sical Prese c r Online Notarization
this da f 2020 by
/ Phy icaI P eser}q r Online Notarization
this day /� 2020.by
,,MA
I NIV/1)(Va`/\�lX�CX
AA06 _4 /V&
Name of erson makin statem t. i
Name of erson
; FATRICIAR. H! L
Personally Kno ' �B'�' �I�Iti��r9�
gpPAT ICIA HILL ra�
Personally K l (JIi I��I�O0
Type of Identifi :;<
YP p ; EXPIRES: April 7, 2024
Produced
Type of Iden ut a
<' EXPIRES: April 7, 2024
`•',•F
Bonded Thru Public Underwrders
Produced o�•'
Bailed-IJuul�.Fublic UnderMrtiters
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
I
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ZONING
SUPERVISOR
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