HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 4 2 G Permit Number:
O
° °\ 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: Wcca e�
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Address: Sk,uc-g, 0ctk2 P te.,c-e 3clR��
Property Tax ID#: -Syna-�dXc`Ua35 `COI 9 Lot No. (a
Site Plan Name: Block No.oil
Project Name:
®ETAILED CRAlIO�N W-
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New Electrical Meter Second Electrical Meter
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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
_Electric _Plumbing ,Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 46S4'0' SOO. Utilities: —Sewer —Septic Building Height:
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Name Name:
Address: (3q-\c �'n Company:
City: :)r. Q\.¢rwt 31k4d.a State:V-k Address:
Zip Code: 3�q�`� Fax: City: State:
Phone No. 1 -�6��'8303 Zip Code: Fax:
E-Mail: �p y¢-c�Jo 2.r .C` Q !:Ca .CO NL Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) 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.
SU PAL
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 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; perfbrm'.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!commencin work or recording our Notice of-Commencement.
nature of Owner/L ssee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed) and subscribed before me of
Physical Pres ce or Online No arization Physical Presence or Online Notarization
this �? day of (:/ 202�by this day of 2020 by
be-"-MS
S
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificatior,� �� Type of Identification.
Produced r Produced
P lLe�— ��� , —
(Signature of Notary Florida) (Signature of Notary Public-State of Florida)
tPRY PU�� '
Commission No. '_� -State iL �al�)AUGF;N Commission No. -(Seal)
�P Commiss o�aa"Notary Public
"7'0' oP; MY Co GG 2200
October p xpires
REVIEWS FRONT S R PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW RE REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.