HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE -COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: C9
91r.
0
Building Permit Application
Planning and Development Services Commercial Residential
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
W(34
E-2
,
ANT LOCATION
Address: JJbQQ S OCA;AN PA J-6V 56AI 0"r-4-11 Sq!l 5L-7
Property Tax ID #: q6-1 27cf 000&ftap (o Lot No.
Site Plan Name: Block No.
Project Name:
L
New Electrical Meter —Second Electrical Meter
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: $ 000 W
Windows/Doors Pond
Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic � Building Heights
X1 2
OWNER/LESSEEddNTk""A&
k" i-Mw
tit
Name V, UA 64 So L.
Name: sTX ext<
Address: 11DOO S. IDCQN DA
Company: =UC-MzzLr — Cot
City: Wew I FW 13CA CV State; rL
Address:- F. 0. -Z 4- z
Zip Code: 54qS7 ' Fax:
City: EW-decko 139rc State--E—L'
Phone No. 772 SS Z 4 ?17L
Zip Code: ±Qci'75 Fax:
E-Mail: JU /dal 6 3 !T m g, C' 0 141
Phone No '1'7 2- Z I S
'J Fill in fee simple Title Holder on next page (N different
E-Mail 1-C-0*4
from the Owner listed above)
State or County License aGe— cktoi 0 -IT
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.
1
�SUPRtEMENTAL CQNS�'RUCTIONLtEN
FQRMAT,Yr.Fi
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xLAWINIO'N
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DESIGNER/ENGINEER: _Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name: �11N �61� �itJG 1 K►�EletiuG
Name:
_
Address:
City: LAr'& ul0&21 State: F<.
City:
State:
Zip: Phone I ��.+���t`
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 landar nr an nttnrnPv hpfnrp rnmmpnrina work or rpcordine vour Notice of Commencement.
Own ssee/Contractor as Agent for Owner
Si=EOF
Signature of Contractor/License Holder
SFLORIDA
Zoe,
STATE OF FLORID�1
COUNTY OF S� Lac,-e
COUNTY OF S'K ..v
Sw Fn to (or affirmed) and subscribed before me of
Swor to (or affirmed) and subscribed before me of
V Physical Presence or Online Notarization
of Physical Presence or Online Notarization
this ,q,L day of DC(' W , 2020 by
this _/ day of t cio.�P�_ 2020 by
Susan 14411 n,en
4�o
Name of person making statement.
Name of person making statement.
Personally Known V OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- F
i re of N
Notary Public State of Florida
Commission No. �`� n O'Donnell
#0 Notary Public State of Florida
Shannon O'Do�y�ej1��
mmISSiOn No. • (���23
' My Commission GG 24e323
Expires 0811312022
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F.xplre8 08J13JZ022
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Rev. S/b/ZU