HomeMy WebLinkAboutSt Lucie County Permit Application Notarized 12-16-20All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTER
Date:
Permit Number:
Building permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fart Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Address:
Property Tax Ili ##:
Site Plan dame:
Project Name: , {' A,
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New Electrical Meter Second Electrical Meter
NSTRUCTI.DN llFIRM�1TlCYN
Additional work to be performed under this permit -check all that apply:
Mechanical — Gas Tank _ Gas Piping
_ Electric Plumbing T Sprinklers
Total Sq. Ft of Construction:.'`
Cost of Construction:
U
tilitie
Y
Lot No.
(";9' Block No. ,
_ Shutters _ Windows/Boors _ Pond
Generator r not _ Pitch
Sq. Ft. of First Floor:
w
s: ewer _ Septic Building Height:
QWIVEFi/I.SL, CQNTRACT3R; i
Fume - ' ='
Address: IL C
City: 1- 0 Z ,,c_ State:
Zip Code:- � `�� Fax: �
Phone No. _ - ` S Y - .- _ z
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: rAPB - e-tr71' e'r--
Company:.
Address. ln -
City: State:
Zip Code- 5r" 5 - Fax:
Phone No _ 7 k _ X I
E-Mail �-cxs tk/& t' a /vj(-7-, i c
State or County License_ L/ ._5 ., z qz_
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.
SUPPLEMENTAL CQNST.R.UCTIION `LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
City: Stage:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
City:
Zip: Phone:_
UWNtK/ LONTRACTOR 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 apermit 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 Nome 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 concurrenq 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 twine 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 attornev hefnri- t`nmmPnr-inrr wnrk nr rarnrrlino Erne it Alnrir-¢ of C.;mn,anror.,a.,t
signafure6f Owner/ tesgee/C nt- r as Agent or Owner
Signafur of n a 66 L c se Holder
STATE OF FLORIDA
f
STATE OF FLORIDA'''
COUNTY OF A.
COUNTY OF 1
Sworn to (or affirmed) and subs�cribgiftefore me of
Sworn to (or affirmed) and sub5srlbed before me of
Physical Presence or line Notarization
Physical Presence ark" Online Notarization
this) A day of 1 �C��_. 2020 by
this 1_1�2 day of t �.0 2o2o by
Name of person making statement.
Flame of person snaking statement.
O
Personally Known Produced identification
Personally Known _J!�011 Produced Identification
Type of Identification
Type of Identification
Produced
LLL
no
Produced
{Signature of N ry !q-o Rte o Flof�llNVY WEBB
(Signature of ry Pub - f �I�r� uplic State of Florid
'; •= Commission It GC 312394
n` mission Expires
Commission NO. M I} +
fey 2023
YP�a'%
_za �_1Notary Public 5tete of Florida
_. •= COMMIT GG 312394
ommission No. -Expires
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'.,, a 23,
, e . My CO lon
'•.'E of s o.`May 23, 2023
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