HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Applicatiortr,.,,; �01R,
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Planning and Development Services - <&40,Fpa
Building and Code Regulation Division Commercial Residentia°%A oo
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
�PROPO,SEDf,1MPROUEMENT,,LOCA�I�
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Address: ►loco S. QCMIJ R, 4?JV $£N &ACN MS-7
PropertyTaxlD#: y5/ 7.101 00000,00 o Lot No.
Site Plan Name:
Project Name:
Block No.
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New Electrical Meter Second Electrical Meter
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:
Cost of Construction: $ SOD 0 . vv
Sq. Ft. of First Floor:
Utilities: —Sewer _ Septic Building Height:
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OWNERjLESSEE
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Name Yt i Dee. Svt. 495vC, :2-04c .
Name:
Address: _ //DID', S"• oCc-Aw DR
Company: t�Ti lee. -ev.✓
City: �, FAc N State: FL
Address:T D Bolt .�G2(a
Zip Code: 3YI67 Fax:
City: Dk,e.0c &&o State:,F_
Phone No. '> 7Z 337- y1-7 2
Zip Code: Fax:
E-Mail: Mt%e 4's 4ismi1 C n iq
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail ���,Q.� ;d q c-oi✓ B% 46 Cd�I
from the Owner listed above)
State or County License G- CoG
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.
SU-� PrPam' �EM>
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DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name: uto"k 6tv"+yEF-r-mG
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Name:
Address: AC, �,C A4 rlwu 4 -
Address:
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City: tn,cE � POT.20 - --' State: re—
City:
State:
Zip: 4c—o _Phone j 1 CAT Se4L
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 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 JAnder or an attorney before commencing work or recording your Notice_ of Commencement.
Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
SwF'h to (or affirmed) and subscribed before me of
✓ Physical Presence or Online Notarization
this day of �� 2020 by
s„s.,f, 14l.11.L.en
Name of person making statement.
Personally Known r/ OR Produced Identification
Type of Identification
Produced
(Signature of Not7'T9V
fid5� -
a. Note Public State or Florida
S annon O'Donnell
Commission No. AIi Rti�nlesion GG 248323
Expires oa/13/2022
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
Swayn to (or affirmed) and subscribed before me of
U/ Physical Presence or Online Notarization
this r / day of 04ZLE&C 2020 by
Name of person ma711
ment.
Personally Known Produced Identification
Type of Identification
Produced
Shannon O'Donnell
my Commission GG 249aal)
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