HomeMy WebLinkAboutBuilding Permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
G 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: 1p---'&Lrz�lr
PROPOSED IMPROVEMENT LOCATION:
S
muul caa. I- - - -
PropertyTaxlD#:
Site Plan Name:
Project Name:
Lot No.4
Block No.
DETAILED DESCRIPTION OF
e �c.,,�s•�-- .; a�n 8-,i�e-�.P _ e a Ylr�t�r• <fl^� Q %-�C� �`� f�F
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 i Shutters —WI d /Doors ® Pond
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: t� �-
Cost of Construction: $
Generator Roof �1 2 Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Nameall
Name:
Address: 10 ( G < L3)4 &nca I I
Company:_ li`1%.V7r:4'1
City: IFO- V -t W-y-CC, State: 34
Zip Code: Fax: h
Phone No.
E-Mail:
Address. 1559 SIF, J LfJL/'i xx
(L(tr
City: I�lll Si
Zip Code: �!)�0'2- Fax:
Phone No . _L_L -- (D 2 1 ° (0 10
Stater
-
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail. 0'W1c(-- D - �� rS ( �C
-
State or County License (` C C
if value of construction is 25o0 or more, a KLLUKUtU IVOEIGe Ol t.V enman%�cu1cnL - Ioy.n
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:
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 and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with len an attorney before commencing work or recording our Notice of Commencement.
ature of Owner essee/Contracto s nt for Owner
gqnature of Contractor/License Holder
TATE OF FLORIDy—�
COUNTY OF �1{- (' If'�
STATE OF FLORIDA r
COUNTY OF Si-l.tto.l&
Sworn to (or affirmed) and subsc ' ed before me of
Swor o (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this' day of 2020 by
Ober _ all
Aef Physical Presence or Online Notarization
this day of (�PJ.Y' bC'r" 12020 by
CuuVw � 'Px
Name of person making statement.
statet.
Name of person m=duced
Personally Known OR Produced Identification
Personally Known Identification
Type of Identification
Type of Identification
P o u
Produced
�#V ON.- Notary Public State of Florida
Pamela Jones
('gnature of Notary P e ffip"frAlp/2a24
C mission No. (Seal)
(Signature of Notary ublic-
Notary Public State of Florida
Commission No. � ppia Jones
(�bmmiss�onGG985470
w a Expires 08rt 512Q24
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 20