HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
S51r015LS�Q15
° t' 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: lun�(
PROPOSED IMPROVEMENT LOCATION:
Address: Q
Property Tax ID#: III D�'l�1� '�)1U-b(xs" O Lot No.�L
Site Plan Name: Block No.
Project Name:1
DETAILED DESCRIPTION OF WORK:
(A W Can t JP�( a � ��, �fl �� GAS �( + Yl � cA) � Tl o
ti o � an-0 CL I 7�
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 _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name r
Name: kA� 0 h
Company: L
Address: `'
City: : State
t�
Address: `"1C35 o Wv/
Zip Code: FFalx:f
City: �__k � State_
Phone No. �11�tDS' U� Ci
Zip Code: _�_1 i Fax:
Phone No �i `{0 1- bC1S
E-Mail i QU
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License I.
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 CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ 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: 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 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 ncing, consult
with lender or an attornev beforie/fommenciniz work or recording your Notice�of Co cement.
Of
Signature of 0 wnee Li " ee/Co
ractor as Agent for Owner
Signature of n actor/License Holder
STATE OF FLORIDA, -
STATE OF FLORI
COUNTY OF k "
L Il A
COUNTY OF > < A
Sw rn to (or affirmed) and subscribed before me of
Physical Pre a ce or Online Notarization
S n to (or affirmed) and subscribed before me of
� Physical Pre ence or Online Notarization
✓2020
day :_1 by
this S�- day of
by
this of
R
V-)
LA (,A Q f::�( (A_1_
� a/ r I AS a
(A C-t
-A _q)n
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known .�<_ OR Produced Identification
Type of Identification
Type of Identification
Produced
Pro ed
(Signature of Notary P =
• :o 116"GO232946
(Sig ature ff
Commission No.
E ��E�e ,line 27.2022
PubGcuM;!Vyfts
EXPIRES: 27r
Commissio "� Pa
sonaaa
Put�lio ra
lennife
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20