HomeMy WebLinkAboutBuilding Permit App All APPLICABLE IN FO MU T MPLETE❑FOR APPLICATION TO BE ACCEPTED
Date: Permit Number.
- O
l= 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:
PROPOSED IMPROVEMENT LOCATION:
Address: I L `` ++ //�t, �y u
c in Property Tax ID#: 1 f V'� ^ 000 ^ Lot No.
Site Plan Name:U Block No.
Project Name: '
DETAILED DESCRIPTION OF WORK:
Qe S C
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Add' 'onal work to be performed under this permit--check a I i that apply:
Z.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: $ L Utilities: Sewer —Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name Name: nc n 1 4 '
Address:-AL. CPJQ
+`�ompany: �
City: State: Address: P'0j. ROS 17 12
Zip Code: Fax: City Statepa
Phone No. — Zip Cade: Fax:
E-Mail: Phone No f q
Fill in fee simple Title Holder o next page(if different E-Mai! W
from the Owner listed above) State or Co my License r nC_ l ?
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:
i
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 fu11 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 commencin work or recording your Notice of Commencement.
Pro I I IV
Si ature f caner/Lessee Contractor as Agent for Owner Signifure of on ractor/License Hol her-
STATE OF FLORID STATE OF FLORIDA -
COUNTYOF . COUNTY OF
S oqi to(or affirmed)and subscribed before me of S or to(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
De e'L
Q 966f�personm king statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known—ZOR Produced Identification
Type f Identification Type of Identification
Pr d ced rod ed
(5ignature of Not y b' -5 tie,a rid4dry P„bird Slee of or ignature oVotary ubli Sfft Flab4q Oubl;o State of Florida
Tlr= Commission:GG 33550' "o" Commission#GG 335501
Fri�`.` m.Expires+gay 5.c' :�� �= a
Commission No. $ } or My C fires May t6,2C23
don d r u h Nat kind i Notar.;.:sr. �ommisslon No. '�
ded LhW'ana Notary A--
Bon .
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
RATE
COMPLETED
eV.