HomeMy WebLinkAboutBuilding Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I { �1�0�
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Residential
2300 Virginia Avenue, Fort Pierce FL 34982 Commercial
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION;
Acldress a ^ —0 5 C26a led
Property Tax lD #: _ G -
Site Plan Name: -t�jo
Project Name: 1 11% 1 T4A7111 lr.or,.,1
ial '�ti Jci Fey&
lerze FL SJTS
M- C7
DETAILED DESCRIPTION OF WORK;
C 0C -b
en CG
New Electrical Meter Second Electrical Meter
I�
Lot No.`
Block No.
w i l l, lzz' -
# CONSTRUCTION INFORMATION: 11 I 1 J I I J
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
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic
OWNER/LESSEE:
Name_ (Qi (,i :L �Sf
Address: L5
City: State: �C-
Zip Code: CL Fax: I) A
Phone No. 7 7a- 5 7D - 3SSS7
E-Mail: ���I rri5}1 e I'nGI �. CQNI
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Roof Pitch
Building Height:
CONTRACTOR:
Name:
Company:
Address:
City:
State:
Zip Code:
Fax:
Phone No
E-Mail
State or County License
!f value of construction is 25UU or more, a RECORDER Notice of Commencement is required.
rr•nnrn ��_.:�-
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicabie
MORTGAGE COMPANY: r Not Applicable
Name:
Address:
Name:
City:
Address: State:
State:
Zip: Phone
City:
Zlp: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: Not Applicable
Name; _
Address:
Name:
City:
Address:
Zip; phone:
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 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 concurrent review: room additions,
accessory structures, swimming pools, fences, wallssigns, screen Booms 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 poste on the jobsite before the first inspection. If you intend to obtain financing, consult
with lend r or an attQey before commencine work or recordine vour Notice of Commencement.
Sign6tur f Ow er es a Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORI-,A STATE OF FLORIDA
COUNTY OF 5-t. L.l&C'X-. COUNTYOF
Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
V Physical Presence or Online Notarization Physical Presence or Online Notarization
this 12 day of'lj, t&Q4! , 2OW by this day of 12020 by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification
Type of Identification Type of Identification
Prod d tysDL' Produced
��;yivo`"••.. LUCYWHEATLEY
Signature of Notary Publ = f F ssion 0M 194'04 (Signature of Notary Public- State of Florida }
'9far r. my Comm. Expires Jun 29 2022
Commission NO. Bondedlh0g�l a4onalholaryASsn. Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
RECEIVED
COMPLETED
I