HomeMy WebLinkAboutBuilding Permit Application i
All APPLICABLE I FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: JL�(1ti�7 a zo Permit Number:
O
v Building pp Permit Application
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:
PROPOSED 1)VI:PR,' VEM;EIVT.LOCAT!`q.Rl
t
Address: L L
Property Tax ID#: /•3 P z— D ` / o Lot No. .
Site Plan Name: Block No.
Project Name:
:.DETAILED Q;ESGRfPTION
t tt i 7r c
i
New Electrical Meter Second Electrical Meter
=:CONSTRUCTION 1:NFORMATION
Additional work to be performed under this permit—check all that apply:
Mechanical _Gas Tank _Gas Piping _Shutters _W`- indows/Doors _Pond
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: nn Sq. Ft. of First Floor:
Cost of Construction: Utilities: —Sewer _Septic Building Height:
''OWNER:L'ESSE-E ``:t CO'IN FRA.GTOR `' 4
Name rPGt /V Name:. AL/ d Q
Address: 7 6 0 fdl L 4 Company: 14 074 pS
City: F f r eYlc.>r r-1 State: Address: 0) n l G
Zip Code: 1 Fax: City: State:r/
Phone No. !` -N Q Z( D U 3-3 Zip Code: Fax:
E-Mail: 'Phone No. 7 Z D 2
Fill in fee simple Title Holder on next page (if different E-Mail DALlr pa yd, 1)A`9 r CG
from the Owner listed above) State or County License /T li �t f o
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.
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DESfGNER/ENGINEER: Not A , . ._ , ,..:r-.:.,>•:<.;:.,:.; ;��i: z 'M.:....:,:..:>„"r�:,, :,,;:ht:.«.
____ pplicable MORTGAGE COMPANY: Not Applicable
Address: Address:
City: State: City; State:
Zip: Phone Zip: Phone:
FEE SIMPLE_ TITLE HOLDER: _ 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 consultrn/ith 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
improveme ' s to your property. A Notice of Commencement must be re Forded in the public records of St.
Lucie Cou and posted on the jobsite before the first inspection. If y 4ntend to obtain financing, consult
with len or an attorneybefore commencingwork or recordingo .r otce of Com F
encement.
Sig at e of Owner/Lessee) ntractor as Agent for Owner Signature of ntractor/r/License Ho der
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY COUNTY OF 1--�
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presen e or Online Notarization Physical Presence or Online Notarization
this } day of C/— ` 2020 by this 3 day ofLP�/. 2020 by
,Q L2�/i��1�
Name of person making statement. Name f person making statement.
Personally Known OR Produced Identifica oh Personally Known OR Produced Identificati�
Type of Identification Type of Identification
Pr uced Pr used
ign ture oT Notary Publi State of Florida j gna re'"o N;gary-°R+�bJo_fYF�lra
��g - f`• �'iSl1t [NO
Commission Commission No. Uk'I14AA4?bRAM-RAHMING Commission N�J ;�Or11dISStON#GG2ntic�i61)
c Q_ W'.y Coi%IMISSION#GG 275060 o r'I " EiXPItiES:December 2o,2022
°FJ; Bonded Thru Noia Pu
blic Undervaiters
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REVIEWS FRONT- PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
i RECEIVED
DATE
COMPLETED
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