HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: ,I
9 1Y. L CUE RECEIVED
94-
DEC 0: e92020
_ Building Permit Application
Permitting Department
Planning and Development Services St. Lucie County
Building and Code Regulation Division Commercial v-"-' Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: C,"7,7_ e4e,
PROPOSED IMPROVEMENT LOCATION:
Address: JCj 13 9 us ::�-- , I
Property Tax I D #: �J % d - -7 D i - GL''70 " ��� 8 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
rL4/I
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 S . Ft of Construction:
q oZ.J� Sq. Ft. of First Floor:
Cost of Construction: $ 41oo Dv Utilities: —Sewer'
—Septic Building Height:
OW N ERAESSEE:
CONTRACTOR:
Names K
pr2
Name: - aC
Company: C (f6�ID
Address: 5 k
'..Address:
City: _ R1 e V-Gp— '' State: L
Zip Code: - Fax:
City: ✓ State:
Phone No. S' LP! D
Zip Code: Fax:
E-Mail:
Phone No 0 3
Fill in fee simple Title Holder on next page ( if different
E-Mail a,(3 nn
from the Owner listed above)
State or County License .5
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 br 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 ag ee 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. Ifyou\intend to'obtain financing; consult
with lender or an attornev before commencingwork or recording vour Notice of Commencement. "
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF 3�_ I &I C1 e..
Sw9 to (or affirmed) and subscribed before me of
i/ Physical Pres ce or Online Notarization
this `i day of Lg✓ 2020 by
//
Name of person making statement.
Personally Known V OR Produced Identification
Type of Identification
Produced
( ignat a of Notary P tic- S orida )JESSICA LYNN JONES
?: q Notary Publif - State of Florida
v !j ` Co missidn k HH 029659
Commission No. o�, '��m:•Expires Oct 15, 2024
%Bondedthrough'NationalNotary Assn
re
STATE OF FLORID ��
COUNTYOF . SJ l(,Lel 4E—
Swo�r1 to (or affirmed) and subscribed before me of
✓ Physical Presvirtce or Online Notarization
thisfe'll
day of ✓Q 2020 by
d !r l
Name of person making statement.
Personally Known 1/ _ OR Produced Identification
Type of Identification �• '
Produced
ture of Yt
t I
ission No.
CA LYNN JONES
Dlic - State of Flor
;sion # HH 029659
Expires Oct 15, 21
National Notary A
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