HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Permit Number: OnA ^
RECEIVED
OCT ® S 2020
9144*11 Mom`
Building Permit Application. Permitting Department
Planning and Development Services St Lucie County
Building and Code Regulation Division Commercial ''Residential 1
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
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Property Tax ID #:
Site Plan Name:
Project Name:
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit— check all that apply:
Lot No.
Block No.
Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ P"ond
Electric _ Plumbing _ Sprinklers _ Generator' _ Roof Pitch
Total Sq. Ft of Construction: 5a 'Ao Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer _ Septic Building Height:
Name rM i'3. & Xah A6W
Address: $54YD arm 6r
City: eru, f State: I
Zip Code: MRS Fax:
Phone No._&. 9�a� • N89q
E-Mail:
Fill in fee simple Title HoldeKon next page (if different
from the Owner listed above)
Name:
Company:, ;v, .-,
Ad'd ress:
'City' n State:
Zip Code: Fax:
Phone No
E-M
State or County License
If value of construction is 2500 or more, a RECORDED Notice oT commencement is requfreu.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER:
of Applicable
MORTGAGE COMPANY: _ of Applicable
Name:
Name:
Address:
}Address:
City:
State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: _1,,fN'5t Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is herebymade 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 applicablefHome:Owners Associationrules, •bylaws.or and covenants.that may rest0ct.or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In corisideration 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 first'inspectipn.. If,you intend to obtain, financing, consult
wit •lender or an attorney before 6inmehdin -work'or"recordin' '•",our Notice of Commenceme`nt.•
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re of wner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA I STATE OF FLORIDA
COUNTY OF S-�, LCOUNTY OF
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this _ day of tYc_. , 2020 by
Name of person making statement.
Personally Known OR Produced Identification
ype of Identificatiq,n,
P-mrii irarl } _ h L
Sworn to (or affirmed) and subscribed before me of
Physical jPresence or Online Notarization
this day of 2020 by
Name of person making statement.
Personally Knowhh` OR Produced Identification
Type of Identification
Produced
(Signature of Notary P (Signature of Notary Public-•State"of'Florida;)-r_
DEANNA MARIE GNENS
Commission No. O MY01010SION#GG022023 Commission No.
EXPIRES: December 16, 2020 `+
Bonded Thru Notary Public Umlenxlters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION `SEA..TURTLE, MANGROVE
COUNTER REVIEW REVIEW REVIEW j,REVJTW REVIEW . �_ ..REVIEW
DATE
RECEIVED
DATE
COMPLETED