HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Date:
'" ° ° " - Building Permit Application
Planning and Development Services Residential
Building and Code Regulation Division COn1nleCClal
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: M C
PROPOSED IMPROVEMENT LOCATION:
Address: U/ r u �6 3
Property Tax ID #: �r- 7 o 5 �d� ���' Block No.
Site Plan Name: the+ —re_
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION: I
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: 44 Sq. Ft. of First Floor:
Cost of Construction: $ QU� Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: �! CONTRACTOR:
Name_ ow 6-^+l Name: OrAndall
Address: as Qa- Company: cAkiwarl
City: C State: �L Address: 56 Sk d M VI Q S 1 11+1
Zip Code: 3 y% S' Fax: v7 7K City: fs L State: —,,EL
Phone No. �� aZ l/ 3 7 Zip Code:.3LI03/ Fax:
E-Mail: Phone No 7a-3'70-1,;L-L17
Fill in fee simple Title Holder on next page (if different E-Mail ch!ynia t eflcadce "nal ' Z arm
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.
W INFORMATION: Not Applicable
�SUPPLEMENTAL CONSTRUCTION LIENcable MORTGAGE COMPANY:
Not AppESIGNER/ENGINEER: Name:
Name:
Address: State:
Address: State: City. Phone:
City: Ztp. of Applicable
Phone _
Zip: �-- Applicable
BONDING COMPANY:
FEE SIMPLE TITLE HOLDER:
Not App Name:
Name: Address:
Address: City: phone:
City: Zip•_
Phone:
Zip: _---- hereby made to obtain a permit to do the work and installation as indica e
lication is her Y permit, act structure
OWNER/ CONTRACTOR AFFIDVIT: ApP prior to the issuance of a p restrict subject
or prohibit such
I certify that no work or installation has commenced p p ants t pt s which may aPPIY'
ritat' n that is granting a permit wiQS authorize
or end covenan d ther at meyd the subs
St. Lucie County makes no represe3ble H our deed for any
TflI lice Ho Home Owners Association r acts, perform the work
which is in con ict with any h our Home Owners Association and reva agree that I will, inAallleesm respects,
-
structure. Please consult with Y of this requested permit, I do hereby g
in consideration of the granting Codes and St. Lucie County review: room additions,
in accordance with the approved plans, the Florida Building oin a full concurrency
lications are exempt from underg g uses to another non-residential use
building permit app screen rooms and accessory a ing twice for
The following Po fences, fences, walls, signs, a result in P Y public records of St.
accessory structures, swimming p Consult
RNING TO )WNER: Your failure to Record a Notice of Commencement may
intend toommencementg,
A o arty. A Notice of Commencement ttons�fbe recorded in the p
W our pr p
improvements to obsite before the first our Notice
Lucie County and posted on the j
with lender or an attorne before commencin work or recor in
ignature of on ractor icense Holder
Signature of Own see/Contractor as Agent for Owner S
STATE OF FLORIDA � �t C
STATE OF FLORIDA
COUNTY OF S �
COUNTY OF goy Sworn to (or affirmed) and subscribed before me of
or affirmed) and subscribed before me of
• I p esence or __
Online Notarization
corn to ( Online Notarization
Physical Presence or_— 2020 by
th' day of � t
of perso making statement.
�J OR Produced Identification
Personally Known �—
Type of identification f
P oduced )
JAIME ORT17. -
te Rfl41�)t GG 223c" : a
igna e of Notar +JfOF �. ` k .toy Fomm E. 'anaI Notary ?ss^ )
_ Physica r 2020 by
thi day of
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Personally Known OR Produced identification
Type of Identification
Prod ed JAIME ORTIZ
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Notary Public -State of Florida
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(5i ture o
�! o ed throw h National Notary Assn.
Commission No.v Z
Commission No - MANGROVE
PLANS REVIEW
SUPVEGETATION SE REVIEW
E REVIEW
SUPERVISOR ZONING REVIEW REVIEW
REVIEWS FRONT REVIEW REVIEW
COUNTER
DATE
RECEIVED
DATE
COMPLETED
eV.