HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE NFO UST BE COMPLETE® FOR APPLICATION "
BE ACCEPTED
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Building Permit Application
OCT12. 1010
Planning and Development Services
Building and Code Regulation Division Commercial
Residen d Itting AeD
2300 Virginia Avenue, Fort Pierce FL 34982
c e Count y
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: / /
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PROPOSEDIIPROlEIVIE�VTLOCATI
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Address: �lil� 0 L 0 /"
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Property Tax ID #: 2,y-1, 0 (0 06 4 o®y
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Lot No.
Site Plan Name: &devi-/
Block No.
Project Name: &&W111
3 041 �-- A-1 t4 Z -I/L - C 11-2 �
New Electrical Meter �_ Second Electrical Meter,
Additional work to be performed under this permit— check all that apply:
Mechanical _ Gas Tank —Gas Piping _ Shutters Windows/Doors _ Pond
X Electric Plumbing _Sprinklers _Generator Roof lZ Pitch
Total Sq. Ft of Construction: Z. i Sq. Ft. of First Floor: 20
Cost of Construction: $ C"67 o Utilities: _ Sewer -Septic Building Height:
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Address: �c C'il7 NpitiU l
City: %I , P r""Ilil� State:
Zip Code: 3 qI i Fax: r f
`City: ' 1"t < s�'L State:
Phone No. %-;7 %i �Z �� l
:Zip Code: �% �GIS l / Fax:
Phone No 27T/fb b 091
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E=Mail: i7A0k11' Y-3 f l 9 l fi^146'e <(`Glll
Fill in fee simple Title Holder on next page (if different
-'E-Mail Ai11,04 t);�ocVeA�b pp 4 Lo%ka
State or County License l'/JC f 3 / 1 Qi
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.
DESIGNER/ENGINEER:. _ Not Applicable
Name: / ftl A) Z 44S/CVL i;l,
Address: '77:' SG_ Po/z.rs7: -tic.: 61a19
City: R S L State: 1
Zip: 3q� e'Phone 0 ,7 z
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:_
MORTGAGE COMPANY: Not Applicable
City: State:
Zip: Phone:
Not Applicable BONDING COMPANY: Not Applicable
Name:
Address:
Citv: _ __-
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 Cou5 rtond posted on the jobsite before the first inspection4f you intend to obtain financing, consult
with lend r of an attorney before commencing work or recordind/iour Notice of Commencement.
SignatS4K of Owner
as Agent for Owner I Signature of Contractor
STATE OF FLORIDA / STATE OF FLORIDA-c�
COUNTYOF L L COUNTY OF ✓! Lt/r.�
Swor r affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of12020 by
Name of person making statement.
Personally Known f OR Produced Identification
Type of Identification
Produp d
ignature of Notary Public- a of Florida )
Commission No. (Seal) r7-N-77
Sworn tt2(or affirmed) and subscribed before me of
fooPFiysical Presence or Online Notarization
this �Qlay of rj/ 2020 by
Name of person making statement.
Per Personally Known '� Produced Identification
Type of Identification
Produced
(Signature of Notary Public- St�!a�,e' of'Fl6rida)
Commission No. // (Seal)
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