HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building 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 IMPROVEMENT LOCATION: q
Address: L " C (sf' UiLt, FJf I(it.
Property Tax ID#: '3qo L(- 0ouq- D C C Lot No. �U
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
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 /,a Roof tr' Pitch
Total Sq- Ft of Construction: f><�- *; Sq. Ft. of First Floor:
Cost of Construction: $ (�I 15 00 Utilities: —Sewer —Septic Building Height: �
OWNER/LESSEE: CONTRACTOR:
Name '°' es Name:
Address: rIV cy d4 Company.'SI ku Ca J t3
City: Stater Address:,1_!2J Q _3 ,,r Sid _I`71 rrV1 'sec utV -- _
Zip Code: ,�4_"/I L4 U Fax: City: iC/1 .Si lu rj� Stater
Phone No. Q- 34 a - ) 9 09 Zip Code: 3Y9 1 Fax:
E-Mail: t - 0 t-''1 Phone No "7 ra-,3yq--7tq 3
Fill in fel simple Title Hold r on next page 4 if different E-Mail s 19 04rg&C f. teyy,
from the Owner listed above) State or County License 0 0C 133631 to
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
11valu
e of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: T Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
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: Rhone: 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 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 commencing work or recording our Notice of Commencement.
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Signature of Ow r/Les /Contractor as Agent for Owner Signature of Corfractbillficense Holder
STATE OF FLORIDA J, ) � �j�' � � COUNTY OF
STATE OF j
COUNTY OF L C.
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me co
of r—�
Physical Presence or Online Notarization L"Physical Presence or Online Notarizatio �9
this i day of ib-t C , 2020 by this-LS(dayof Df('� 2020 byT_
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e 4J cy)
Name of person making st tement. Name of person makink statement. 'n a)z-La � C
Q o E
Personally Known "�� OR Produced Identification Personally Known \1 OR Produced Identificati �E d
Type of Identification Type of Identification
Produced Produced o )2
riA ignature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida )
cf R6 Y I �1!l SS1
�o tiCl1mmission No. (Seal) Commission No. (Seal)
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a m VIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
p COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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