HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: / � • 3, " ' Permit Number:
S51U ILUEr,
RECEIVED
Building Permit Application DEC 2 3 2020
Planning and Development Services Permitting Department
Building and Code Regulation Division Commercial xx Residential St, Lucie County
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: �� � 0144� Ua4d�_rr_p �Q
Address: 3406 DALE PL, UNINCORPORATED SAINT/ LLUUCIE COUNTY
Property Tax ID #: 2 V oo 6 lam' Lot No.
Site Plan Name: Block No.
Project Name:
New Electrical Meter Second Electrical Meter
1,
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters —Windows/Doors _ Pond
Electric _ Plumbing ^J —Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: 1 -/ 6 4 Sq. Ft. of First Floor:
cc
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
Name 4- Name:
Address: Company:
City: r� State: F` Address:'
Zip Code: Fax: City: pr-State:
Phone No. Zip Code: 30�C5 Fax:
E-Mail: H phone No Ir
Fill in fee simple Title Holder on next page ( if different E-Mail filth
from the Owner listed above) State or County License ((�Or0 Li6�(.
f value of construction is 2500 or more, a RECORDED Notice of Commencement,is
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/E G IN E R: _ Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: Stater City: State:
Zip:3� (Ty Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: � Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 post the jok�site before the first insge�ti�q. If you intend to obtain financing, consult
with lenders at efor ommencing work or re(�cbb di. 0 your Notice of Commencement.
ignature of 0 'e)r44.eaLegX-cr6traffbf as Agent for Owner
i a ntractor/License Holder
SLAT OF FLORIDA
STAT F LORIDA
COUNTY OF BROWARD
COUNTY OF BROWARD
Swgrn to (or affirmed) and subscribed before me of
✓
Swor to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Presence or Online Notarization
this day of WC 2020 by
this day of L��QaZ020 by
JAYSON ONESCHUK
JOHN SETTON
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 n �p
�S ,/���?�/
Produced
Produced �.
(Signature of Nota U Qate ofp(Ajr CII&)4NN CHACONJ
(Signature of Notary
b a of IRA�fil61� ANN CHACON
' ° = MY COMMISSION # GG 3614
_: = MY COMMISSION # GG 361474
Commission No. `�' r< EXPIE�6»aApgust1,2023Commission
No.
'o`= EXPIIgust1,2023
Bonded ThPu Notary Public Underw
Bonded Thru Notary Public Underwriters
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DATE
RECEIVED
DATE
COMPLETED
ev. 5/6/20