HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: ` ("� ��• 7� Permit Number: �O
0� [LOME RECEI�/E®
o �r 1 4,2020
Building. Permit Application irr�ltfiil�� Department
Planning and Development Services �sf,!ucle County
Building and Code Regulation Division Commercial t7Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
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PRQPOSEDIM'P OUE=MENT LOCATION � �#Y ` art^ ��33j � � � ;
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Property Tax ID#: r Y 7 `` Lot No.
Site Plan Name: ASK / Block No.
Project Name: G t'S
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DE�TAI;LE'D;DESCRIPTI03 ®fnWORKa �'� �
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New Electrical Meter Second Electrical eter
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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: Sq. Ft. of First Floor:
Cost of Construction:$ � ) � Utilities: _Sewer _Septic Building Height:
a � ? ,� `� CONTRACTOR
.�i��'S �
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ame QM Cb L [60.. r
Address: l etZ=' ompany: S
City: - A ee ate: Iddress:
Zip Code: L�`j V -7 Fax:..S ( 3'2 QU5 City: Vellb AeAk Stater
Phone No. 6 7 , C y ' K '•Zip Code: J� f(_1 Fax:
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E-Mail• 1J( I'( (I'e �Cl?,l U rt6,_r'e D,,A I^bW Phone No
Fill in fee simple Title Holder on next page(if different E-Mail b S
from the Owner listed above) State or County License
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.
SUPPLE#pg��ERITA'L CdNSTi �11C�T10'NLIEN L;�1N:�IN,FORMY a4TION��{� �_' �� ' :°` F� `��'�� ±�� �
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DESIGNER/ENGINEER: —Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: Stater.
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 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 Commence ent may result in paying twice for
improverrgents to your property.A Notice of Commenceme ust be recorded in the public records of St.
Lucie C linty a posted on t lobsite before the first ins tion.If you intend to obtain financing, consult
wit nder an orn ore commencing work or r rdin our Notice of Commencement.
/ ( '0�r —
ur Ow r/Less 1
/Contractor as Agent for Owner ignature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF $lr COUNTY OF �I&L 4 C,,
Sworn to(or affirmed)and subscribed before me of Sw rn to(or affirmed)and subscribed before me of
Ph sical Presence or Online Notarization Physical Pre! nce or Online Notarization
this day of 0064 c z 2020 by t is day of C, lzr 2020 by
E/,VA G Qi?y 1�� TiZ . _h
Name of person making statement. Name of person making statement.
Personally Known Y OR Produced Identification Personally Known X—OR Produced Identification
Type of identification Type of Identification
Produced tSIM
Producegh
(Signature of oLL (Signatur of otary PWpm
on 204495yy� � �iGCommission No. .2021 Commis n No. I�1•2W
BadolhuDklryAM
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED