HomeMy WebLinkAboutBuilding Permit Applicationly APPLICABLE INFO MUST BE COIV,a__JED FOR APPLICATION TO BE ACCEPTEG"--
Date: C�—� �_ o`� D � d Permit Number. 011. "08co
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: do /J e r2E''2- SLA 8
Address:
Property Tax I D #: 3 t-i N— 50 i— H (No -- 1 00�a t
Site Plan Name:
Project Name:
Lot No. (Q
Block No. 0
DETAILED DESCRIPTION OF WORK ;'r
i50 S4-,�
• &I n, to 2 r% m
Ji SLR - y
1 X,-t I m n -f ,o v^ W s 1?_ E ova R ? 5.. .��.
New Electrical
Second Electrical Meter
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: —1_
_ Generator
_ Windows/Doors _ Pond
Roof Pitch
Sq. Ft. of First Floor:
Cost of Construction: $ e>( I d�zT) Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE ;CONTRACTOR
Name J n n .
Address: D
City:(-`t. , ( i, A i P State. -EL -
Zip Code: Jlf OQ Fax: �� }
Phone No. �772--539-Q°14a,
E-Mail: \ M C.(�S�I`�11�
Fill in fee -ample Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail
State or County License
IT value oT construction is Z5Q0 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: _ 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 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 l 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 attornev before commencing work or recording vour Notice of Commencement.
Sig ature of Owner/ Less or as Agent for Owner
7
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF S� = /_ icc / C�
COUNTY OF
won to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Pres nce or Online Notarization
this � day of NO BE 2020 by
Physical Presence or Online Notarization
this day 2020 by
of
Aa.i-of
ement.
person mak7011
Name of person making statement.
Personally Known Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Nota ublic- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. 1; a �aq!�r' I) WILLIAM H DON
MY COMMISSION #
V"s ion No. (Seal)
G093576
REVIEWS
FRONT
•un
ZONING
VEGETATION
SEA TURTLE
MANGROVE
SUPERVISOR
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
-
Kev. :)/D//-u