HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
LUCIE—
' COUNTY
Building Permit Application
Planning and Development Services r
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: be j d 3-6 0_S
Property Tax I D#: S z O 1 o e 0 I ' G g o Lot No. Z
Site Plan Name: J ot- Cy 11 4C, Block No.
J Project Name: 6
DETAILED DESCRIPTION OF WORK:
n '(r �U P. rl7 n
New Electrical Meter r i o iI .r Second Electrical Meter (1 0 )7)
CONSTRUCTION INFORMATION:
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: $ A67' Z e0o, CC) Utilities: _Sewer _Septic Building Height:
OW N ERAESSE E: CONTRACTOR:
Name NATASHA JORDAN Name: leenc4rWi-
Address:13605 S INDIAN RIVER DR Company: r".� �rl,_A_
City: JENSEN BEACH State: FL Address: tLb Y QR cy< Y+c
Zip Code: 349r97 Fax: City: . n /) 7 L State:
Phone No. 772-777-9940 Zip Code: ,4 qq 64 Fax:
E-Man: SUPERGLASSFL@gmail.com Phone No 7 .7 Z, 2-6.3 Z —7 6
Fill in fee simple Title Holder on next page(if different E-Mail e-Lo n u S' + 'got , G
from the Owner listed above) State or County License j 3 ")°n
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:
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, 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 ob in financing, consult
with lender or an attorneybefore commencingwork or recordingour Notice of Co encement.
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Signature of Owner/L s /Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA // STATE OF FLORIDA
S COUNTY OF 4 G� C' COUNTY OF M +n
Sworn to(or affirmed) and subscribed before me of Sworn to(or affirmed)and subscribed before me of
✓ Physical Presence or Online Notarization _-4 Physical Presence or Online Notarization
this�_day of icw Ce rwLo�� --,2020 by this_a_day of . �CA-n 2020 by
c)1iS LYc ) ci-,cP
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification l� Personally Known V OR Produced Identification
Type of Iden,J,Lcation Type of Identification
Produced L Produced pQNM�t1ELjflrr/ij*
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(Signature of Not y State MliaoidmyEPH '(Signature of Notary Publ -St to loj
Notary Public-State of Florida �.• —_
.�• Commission 5040 �r
Commission No. *{orh5 Commission No. Se ytd�ts t; Qz
mm.Ezpi es a 3,2022 C
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TUR fAi (hVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW EVIEW
DATE
RECEIVED
DATE
COMPLETED
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