HomeMy WebLinkAboutBuilding Permit All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 201 7-- OQ/a a-
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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: _113 moo/ teoD rigrcLC
PropertyTax iD#: Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
4)Nrc La hns,t 1,, 14- A• iW ♦•'dLL G-FL. r 6nl f- i .Gt- Is 1 N J V
-7,000 „wires 'tot Lei
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank L Gas Piping `Shutters _Windows/Doors _Pond
.,lElectric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 7(A) Utilities: —Sewer _Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name #L �Qqt 8ogde Name:' . 5 . /Y),,DLG
Address: ,^cCa Company:._c, • XaoI-r; r Le- cfr-ctLlc
City: 11} Vie rc r State:f1, Address:_ �-I$' E. Wrf- 6 .r pr
Zip Code: Fax: City: LIf4re 6 r% a c h State: CL'
Phone No. Zip code:1, 6 a Fax:
E-Mail: Phone No
Fill In fee simple Title Holder on next page(if different E-Mail— M c u Y 9 D i
from the Owner listed above) State or County License e L I d D D ! L L
if value of construction Is 15W 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:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _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 clothe 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 Mender or an attorney before commencing work or recording your
Notice of Commencement.
Signature, wner/Lessee/Contractor as Agent for Owner Sign�of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5-f Ltic;e COUNTYOF S,L Lu� r
Swfrt to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
_ to
Presence or Online Notarization ✓Physical Presence or Online Notarization
this_day of 2020 by this_day of 2020 by
Name of person making statement. Name of person making statement. -
Personally Known OR Produced Identification_!L Personally Known OR Produced Identification
Type of Identificati n Type of Identificati
Produced Produced
o.u„q..
(Signature of Nota b i -State of Florida ) q (Signature Notary Puy-
State of Florida )
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Commission No. (Seal) o m=, Commission No. (Seal) i on
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