HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED !� v
Date: ),;R • ,G �• Permit Number: C�o `X
pRECEIVED
O
DEC 2 3 2020
17-12 Building Permit Application l3e''emittingDepartment
St..Lucie County
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: C P cc PO Tel)
'PRUPDSL} IMPR®1MLNTL'OxAT�ION Y - 'k � '�''�
Address:
Property Tax ID#: Lot No.
Site Plan Name: !T:�ip, ng �+���. Block No.
Project Name:
DxETA�DDS�GR PTA
New Electrical Meter Second Electrical Meter `�T�21r- Vl P6AA,
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Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors. _Pond
14-1 Electric --15-Iumbing —Sprinklers —Generator —Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 15(o0 Utilities: _Sewer Septic Building Height:
w.,,_ �e je. o F;S, 'S^'�r rt- ..s,�aaprx {�. �t*�� .. - _ ..�.z Y-;
OWNER/LESSEE h y , �°' rx `,_'z��0_NTRSACT®R "� r "f�
; tiY�'.!a. ' 'i'J....: __.'°s it'-,A.. s0+151-11 .�. { O."�fi+arSa'y'+ "3..n.::3'L 3'Z;�r�.7s�,`�vti� :l." �t+V�:.�`-.l". r _.�. -Ix .:;3,:1 ekd.'m'��` r'i~F:
Name ( V Name:
Address: U V ) , Company:
City: State:RL Address:
Zip Code: 1-zlu(e Q9_ Fax: City: State:
Phone No. ;I2 rJ19 Zip Code: Fax:
E-Mail: YXr) k Phone No
Fill in fee simple Title Holder on next page (if dif erent E-Mail
from the Owner listed above) r COVE State or County License
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.
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: l 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 d posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with len n attorney before commencing work or recording our Notice of Commencement.
SignV0FfFLCRIDA
her/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
ST STATE OF FLORIDA
COUNTY OF COUNTY OF
Swor o(or affirmed)and subscribed before me of Sworn to(or affirmed) and subscribed before me of
Ph sical Presence or Online Notarization Physical Presence or Online Notarization
this day of '1�0 t-t 2020 by this day of 12020 by
N es-Pb g_ r- I Gist,e R eV
Name of person making statement. Name of person making statement.
Personal) nown OR Produced Identification Personally Known OR Produced Identification
Type of Identi ion I Type of Identification
Produced ► / C.. Produced
J;�
(Signature of No r Pu ic- (Signature of Notary Public-State of Florida)
.;� �; AUDREY B.HU°v1PHREY
Commission N :z� MISSI003'a@1 0817 Commission No. (Seal)
9o: EXPIRES:Ivisrch 6,2023
o i F:;'7cUnderxriters ,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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