HomeMy WebLinkAboutBuilding Permit Application i
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r� a
Date: `2-00 Permit Number:
94To[LUCDG -
..°f 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:
r
PRI�POSEDIMFROV�ME,�IT LOCATIQN'
Address:-T9 nP_e c� �X . ET? �L {31 /q 5
Property Tax ID#: ��1�L_ � ^OC�O� -• (�(j('}--� Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTfON CrF41N:ORK
New Electrical Meter Second Electrical Meter
CONSTRUCTIQN INFORfATION }
e
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 Construction: Sq. Ft.of First Floor:
Cost of Construction: $ - Utilities: —Sewer _Septic Building Height:
OWNER%LESSEE ;n C®NTRAGTOR r
Name 4ArtR.`z Mr,%twiaLL Name:
Address: 40i? Sn_Crts Rh Company:
City:�PbAT Prr-'1RGt5- State;FL• Address:
Zip Code:34ARg5_ Fax: ,,, City: State:
Phone No. .Slot- a 104 Zip Code: Fax:
E-Mail:claues(Ivcbai 4 M&U- r-&t Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
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,UPPLEMENTAL�CONSTRUCTl' N LIEN LAW'fN'FORMATION y
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: F32r,1. t< l ;_�ja�Ps" Name:
Address: Ca-L, 04ve, Ste. Address:
City: Vim_ C �-„r 1^ State: f=L. City: State:
Zip: ?i-LCt(t22 Phone 7_1�z \—AgT0 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 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_Qr an attorney before commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/ ntractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLOF�A STATE OF FLORIDA
COUNTY OF - U_Lc_u, COUNTY OF
Swop to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
✓__P66hy�sical Prese ce or Online Notarization Physical Presence or Online Notarization
thisa day of_ R_ tA'iC 2020 by this day of 2020 by
Da yl GL
Name of person making statement. Name of person making statement.
Personally Known_ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Prod ced Produced
IS
ignatur of 'c-State o "C Sna Signature of Notary Public-State of Florida )
�LZaSP�v
Y P�ftft of Fbrlda
Commission NCanNaslo�6E res("J 2022 Commission No. (Seal)
Camiksim No0.GO 177670
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.5/6/20