HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONh
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: • "1• �"• Permit Number: ,=2 of �2' b-.2-S-5
RECEIVED
01ro L UCIELE � DEC 012020
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° Building Permit Application Permitting Department
St, Lucie Coun
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: ',.�Ld_A_�
Address: 3
Property Tax ID #:
3t{qZ-)-
enwat)
Lot N o.
Site Plan Name:/SG! �eN O Block No.
Project Name: L- SC.i O 2c-l"i v
New Electrical Meter
- /nd77)-AV(OS 000-
Second Electrical M
Additional work to be performed under this permit— check all that apply:
Mechanical Gas Tank —Gas Piping _ Shutters Z Windows/Doors — Pond
0�4_z
;,"Elearit — Plumbing _ Sprinklers _ Generator —Roofs - Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 3 D. a 42� O
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height: -
Name
Address:
City: r P 3 c-,*+ State: FL -
Zip Code: 3 Fax:
Phone No. a ' G1 ( ` �� a
E-Mai(: S� IS �Z�j 14_5'
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:31
Company:
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail
State or County License
_L /•�.—.— ..� is rontllr�ll
If value of construction is csuu or more, a r%r'_W W. ..• - ••••••—••--•------ --
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
13 18
DESIGNER/ENGINEER:
Name: "'�°�
Address:
Not Applicable
PJL^"r►"�-n�.
MORTGAGE COMPANY: _ Not Applicable
Name: C S`
Address:
City: State:
Zip: Phone:
City: State:
Zip' W31 9707Phone 7R2-6 6(-9'7a9
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Address:
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 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 i-n the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
! I- -_-1_ _ +, ._..... I,-,C-, , i.,rt..,,,rle nr rornrHina ymir nlntirP of Commencement.
Signature Own / Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
C.
STATE OF FLORIDA
COUNTY OF
COUNTY OF 1
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Online Notarization
Physical Presence or Online Notarization
Physical Presence or
this day of , 2020 by
this day of 2020 by
.St ndre, Lisp ; o
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identifi tin I
Type of Identification
Produced 1'r- 1
Produced
(Signature of Notary blic- State of Ida
(Signature of Notary Public- State of Florida )
•tpP� Pb • AUDREY B. HUMPHREY
Commission No. S
Commission No. (Seal)
—03008t7
EXPIRES: March 6, 2023 k
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