HomeMy WebLinkAboutbuilding permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
COUNTY
Building Permit Application
Planning and Development Services / Building and Code Regulation Division /
2300 Virginia Avenue, Fort Pierce FL 34982
Commercial Residential VVV
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR..
PROPOSED IMPROVEMENT LOCATION
Address: J6 /) fi I" / h r,.
Property Tax ID #:
Site Plan Name: 1
Project Name:
-! bI- &5-14'-
E L 305 --�-
00 ��
DETAILED DESCRIPTION OF WORK:
writ �" buck 6 3
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
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ _4b -
OWNER/LESSEE:
Generator
Lot No. �{
Block No.
Windows/Doors _ Pond
Roof Pitch
Sq. Ft. of First Floor: _
Utilities: —Sewer —Septic
Name &,(,t V,
Address: 2 O Tb
City: 25 L State: L�
Zip Code: ,3 L/'J 5,-- Fax: cL
Phone No. - 710�'
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name:
Company:
Address: /_§_b
City: Ml_
Building Height:
C
Zip Code:3 Vq ?j Fax: n State:'_-
� �
Phone No - p_ 7,} t
E-Mail ' k 0 te 0 f e
State or County License Jq ,-7— I GYti
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
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 recprding your Notice of Commencement.
Signature of Owner/ Le ee Contractor as Agent for Owner
ignature of Contract tLiceose Holder
STATE OF FLORIDA
COUNTY OF 1— �—V e— e
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
worn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
th—is )�i day of N . 2020 by
N Phyysical Presetice or Online Notarization
this .. �} `aay of Dya �r, �2020 by
(y�'da.,�e11_
4 A .— � 1-4k—` Q.
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i� A ti p S hl Q
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Pr duced
Personally Known OR Produced Identification
Type of Identification
Pro ed
( ture � Notary Public- State of Florida)
tur No(t�ary Public- State of F orida )
Commission No. `� : �yir'v�B., (Seal) JAIME ORTIZ
-:° • 4� Notary Public -State of flor
a' o' Commission # GG 228444
C mission No. V Z ;' /AY PLB�seal) J V IZ
da ?° • • �': Notary Publlc •State of
Commission KG{a I7,8!
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