HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
l • n 7.
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: Oft— "I; 169'ple
IMPROVEMENT LOCATION: m,
Address: '� -_ 1 �: L ji`i l / i /,- -i i L' t__ ;
Property Tax I D #: -3V 19 01 lts 000 ' Lot No. I
Site Plan Name: Block No. 3 7
Project Name:
New Electrical Meter Second Electrical Meter
LNS'1 RUCTION INFORMATION:
__�7
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:
Cost of Construction: $
OwNERjLE55
Name T Y
v Windows/Doors _ Pond
Roof Pitch
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
Address: 33 J 50, 6 4: �P/ zl (Lft"
City: F State:
-
Zip Code: Fax: T
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: 1)LMYY
N!W L
Company:
D6W.S A*P
04Z_
Address:
37
City: mil`'=
Ill--7—C-6
State:
Zip Code:
�47 q_
Fax:
7i} —�j � g633
Phone No
12 ") "` m —V roI
E-Mail Jegnn
•''Sav Ync>v,-__fiC
State or County License
133 15yo
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.
W
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 lender or an attorney before commencing work or recording our Notice of Commencement.
11 (2�__ /L
�' 6"' �0'
� 4-t'�
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF ,u . o
STATE OF FLORIDA IfL IF
COUNTY OF 152r Yzg,
Sworn to (or affirmed) and subscribed before me of
Physical Pr nce or Online Notarization
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of 2020 by
9X_
this R_!!day of kJ 2020 by
"'._)
k9l- LV)L� AL
Name of person making statement.
Name of person making statement.
Personally Known '� OR Produced Identification
Type of Identification
Produced
Personally Known ✓ OR I
Type of Identification ;SEW. BEM PRIDE
Produced �—
�`= Commission#GG198661
:.:
d Expires July 2, 2022
BmW IM Troy Fain Mum)"
8
(Sig ature Of Notary Public- State of Florida)
(Sig ature of Notary Public- State of Florida )
Commission N RIDE Sea
Commission No. (Seal)
�;t Commissw 1 GG 198661
REVIEWS
COUNTER REVIEW
9 • OR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEATURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Key.
� 5-7019