HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: - - Permit Number:
NJ llo
O -
p 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:
PROPQSED.IMPRUEMENT LCAT_ION
Address: � 3 , z
PropertyTaxlD#: Lot No.
Site Plan Name: - n �km_t' �-, (Yl i Block No.
Project Name:
i
RET�i �D:DESCRIPTION OF 1NORK -
., 6 I
New Electrical Meter Second Electrical Meter
GONSTRUCTiON INFORIVIATIQI�
Additional work to be performed under this permit-check all that apply:
I
ILMechanical _Gas Tank —Gas Piping Shutters Windows/Doors Pond
i
Electric T Plumbing —Sprinklers _Generator Roof Pitch
Total Sq, Ft of Construction: Sq. Ft. of First floor:
Cost of Construction: $ Utilities: _Sewer _Septic Building Height:
OWN1=Rf LESSEE CONTRACTOR'
Name ern _ 5C,-S Name: 1 ()CkLLO �ILCIL
Address: Company:
City; State: Address: ` O
Zip Code: Fax:`1�a ` yi 4f o6 City: J - eJA State:_
Phone No i Zip Code: �t - _ Fax: �i j_
E-Mail: \WIL o 1 " •0 Phone No 9st/f -q
Fill in fee simple Title Holder on next page(if different E-Mail �� xr.2�
from the Owner listed above) State or County Licensetrl� '
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.
S; PPtEM {TAI�CONSTRUCQN,LN EAW {NC)ftN1AT{ON7777
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,
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 thls 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 attornev before commencing work or recording our Notice of febmmencement.
Signat re of Owner/ ssee/Contractor as Agent for Owner signat a of tractor/ ense Holder
STATE OF FLORIDA _ STATE OF FLORID"
COUNTY OF t Y � S -�` COUNTY OF L f.`�,.�"-
Swor o
7 (or affirmed)and subscribed before me of Swarn o(or affirmed)and subscribed before me of
Physical Presence or Online Notarization Physical Presence or_ Online Notarization
this day of 2020 by this day of 2020 by
Name of person making statement. Name of person making statement,
Personally Known 011 Produced Identification Personally Known cam` OR Produced Identification
Type of Identification Type of Identification
Pr duced Produced
(Sign Lure of N N (Signature of Notary Public-State of Florida)
JULIE BARREI-f CATALINAVALERIA MORALES
e ;. Notary Public St orida C9I11mISSiOn#GG944
Commission�l * deal)
Commission No. :S7 '" issivn N G 42 Expires January 6,2024
My Comm-Expires Sep 28,2p22
Bonded thrvugh Natiopa..y �OFfo BaDded7hmfludget Notary 8oMm
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 576720