HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MOST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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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:
PROPOSED IMPROVEMENT LOCATION:
Address: SCE
' ,e �- C� `4 ,01
Lot No.- G—
Property Tax ID 4:
Block No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
N ✓ 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
Electric Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $
Windows/Doors — Pond
Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name e
Name: �,C-A(92,r_ k�
Address: L�-
Company: _ `d1
Address: lA
City: State:
Zip Code: °�5_ Fax:
City: �� StateV
Phone No.
Zip Code: Fax:
Phone No
E-Mail:
Fill in fee simple Title Holder on next page ( If different
E-Mail Tri1 ll �L iNV1
State or County License c- r
from the Owner listed above)
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: I
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
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 ana Installation as inoicatea.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lurie 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 lenderer-an attorney before commencing work or recording ~,Notice of Commencement.
Signature n ssee/Contractor as Agent for Owner I Slgnature of ICcikractqVicense Holder
STATE OF FLORIW_ _r I STATE OF FLORIEFA QL., k
COUNTY OF i ! ��C% _ COUNTY OF,
Sworn to (or affirmed) and subscribed before me of
Physical Preclence or Online Notarization
this ay of 2020 by
CIED [,I I04J_
Name of perstn making statement.
Personally Known OR Produced Identification
Type of Identificat' n
Produced
(Signature of Notary Public- State FiDnded
_]
YADYRA MARTINEZ G(
)Notary Pnbllc • State c
Commission No, �r ft 1 �} Commission I8H 7
My Comm,ExplresAug
through National Ila
REVIEWS I FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Sworn to (or affirmed) and subscribed before me of
Physical Pre once or Online Notarization
t is day of ZCP 2020 by
Name of persA making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
z �ln ure of Notary Public- State YADYRAJOAFINEi
Florida Notary %Wc • State Of
�y�t Commtsstor + HM ] i
D 202a 55ion No. .4214 Comm, EXosrts Aug
re Assn. Bonded through Nattora: Not.
SUPERVISOR REVIEW RE EW I VEGETATION
I SEA REVEWE I MANGROVE EVl W