HomeMy WebLinkAboutbuilding permitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
O v
Building Permit Application
Planning and Development Services
Building and Code Regulation. Division CommerCia I Residential
2300 Virginia Avenue, Fort Pierce FL34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: 6 ZZ- % fewnt 1t✓ o— DQ TC, /
Property Tax ID #: tU �O 0 Q)3-4 — �)Cy>-w `"r
zz
Lot No.
Site Plan Name: Block No.
Project Name f)irl Q Gon(w
New Electrical'Meter Second Electrical Meter
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: —t S
Cost of Construction:
Na
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Utilities: —Sewer _Septic Building Height:
Address:) 22-1 toe WAX -
City: fiTrr pler a !( State �—
Zip Code: �J �( Fax:
Phone No. a 6 (� 0 24 33
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name:
Company:
6.
Address�'-)lln c7l-U-) U-01(0 'VU)rz,>l WlU/�L.
City. l (1^T C_7;,1,C). � State: L
Zip Coder w i-�:) Fax:
Phone No-
E-Mail
State or County License CICIL
If value of construction is 2500 or more, a RECORDED Notice of Commencement is requires.
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:
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 an d on the jobsite before the first inspection. If you intend to obtain financing, consult
with Ipndpr tt rnev before commencine work or recordine vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signatu fontr Icense Holder
STATE OF FLORIDAOLL
STATE OF
COUNTY OF
COUNTY OFORID4�
'
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 nlirie Notarization
`_De this I day of CaWV 2620 by
this __L_ day of�_M 2020 by
v�1
Name of person making statement.
Name of person making statement.
Person y Known OR Produced Identification
Personally Known OR Produced Identification
Type o den ific on
Type of Identification p
CIL-
Produc d 1
Prod ced 1
(Signature of Nota u 'for�tatiWr f k "j 'te of Florida
(Signature of Notary b ' to hDF*Wo)8tate of F10604
ADOLI MIRONGHUIf
ADOLI MIRONCHUK :,
c My commiMb 098831 T`
Commission No. Q
F¢ My Commi iorl 4 0€ 0531
Commission No. o- Expires-04�1
xpires-0.4 1
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