HomeMy WebLinkAboutpermit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12/2712020 Permit Number:
Jr
` ` L` `1l Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1SS3 Fax: (772) 462-iS78
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: GQ '5C St Vk 4 C-7 FL L 3
Property Tax ID #: - 5 - noo - Lot No. 5
Site Plan Name: f r Block No. N
Project Name:
DETAILED DESCRIPTION OF WORK:
1
J
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 X Plumbing _Sprinklers — Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
�y
Cost of Construction: $ G� .q�J 1_.�j (X Utilities: A Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name i �
Name: U l
Address: '-Q
Company: PaVruS()h r��0
City: PS L, State: EL
Address: I _A mo sl-
Zip Code: - � Fax:
City: (— State: L-L
Phone No. _ . LAD " W
Zip Code: G}—'I) fax:
E-Mail: C U
w
Phone No 2Y44
Fill in fee simple Title Holder n next page ( if different
E-Mail
from the Owner listed above)
State or County Li ense
if value of construction is 25W 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.
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PPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
SIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
me: 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 financing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
K
Signature of Owner/ Lessee/Contractor as Agent for Owner Sig azure Contractor/License Molder
STATE OF FLORIDA STATE OF FLO '
COUNTY OF COUNTY OF Cl
Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization 7c ical Prewnce or Online Notarization
this day of 2020 by this day of CeM 2020 by
rry4a n he& Vo
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 Produced ++ Notary Public State of FbrKM
Lissetle I. Diaz
'd'- My coma sum HH 019303
pin Exgres07i
(Signature of Notary Public- State of Florida) iGfT� , itti St
Commission No. (Seal) Commission No(Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
e�7 2
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