HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BECOMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �'�, NS' a�1 Permit Number:
RECEIVED
94 DEC i 6 Zino
0
° Building Permit Ap plication
Plirmltting Department
Planning and Development Services 411. Lucie Cou
Building and code Regulation Division Commercial Residential
-
1300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR: S' r� J1 j) L fVfd/tg rt AI
Address: 7 r? 'SQL e2
Property Tax ID#: /�`7 3� 601— CV b.? —&Vo Lot No.
Site Plan Name: NORM ON✓ /r`l�• h�� _ _ Block No.
Project Name:
/2L' /wd � s��=�� � -S Vic/ H, .L ,/ � ✓n2c,✓f /fir' cis, �e f ��j1/s_,�
r �P
New Electrical Meter Second Electrical Meter.
NCO 153TtRTI'� I p k _
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors J �_Pond
_Electric _Plumbing _Sprinklers _Generator __!!"'Roof � //oC- Pitch
Total Sq. Ft of Construction: Ale d Sq. Ft. of First Floor: �T'�
Cost of Construction: $ Sn�� Utilities: _Sewer _Septic Building Height:
(}rxaea� 3: . .. .
Name Qi✓,W L Name:
Address: 2�Ob A Ve r� S>` Company:
City:j!ii 6 l,Lrce State: Address:
Zip Code: 3y9 yA Fax: City:
State:_
Phone No. 77.2— OZ-9" 9972 Zip Code: Fax:
E-Mail: 5/ a r 'A/ �03 �s �iD�' /�rN Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
if value of construction Is 2500 or more,a RECORDED Noi of Commencement is required.
If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
U;PP- O u IN s
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip• Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _No pykeable 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 and applicable Homeowners 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 lender or an attorney/before commencingwork or recordin our Notice of Commencement.
Si ature ofo owner/Le�ontract as Agent for Owner Signature of Contractor License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF���.��_ COUNTY OF
Sww fn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
✓✓ Physical Pre VW or_Online Notarization Physical Presence or_Online Notarization
this day of eC� •2020 by this_day of ,2020 by
Name o erson making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of ldentifi n Type of Identification
Produced l i Produced
(Signs re of No - I ELSEN (Signature of Notary Public-State of Florida)
P >yB i
its State of Florida-Notary Public
Commission No. __ •= commissioOMP 207a8a Commission No. (Seal)
My Commission Expires
iw June 12, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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