HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: "1` Permit Number.`: O ' ' l
01ro-
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~° Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential k
2300 Virginia Avenue, Fort Pierce FL 34982 -
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
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'PR®F�OSE'DItM,RQO/ IAVI:ENT"L TIO,
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Address: 101L 5-
Property Tax ID'#: 93US 14-�> F9da I Lot;No.
Site Plan Name: Block No.
Project Name:
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New Electrical Meter Second ElectricaWeter
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 r Roof ��iZ Pitch
•E V�`t
Total Sq. Ft of Construction: &o Sq. Ft. of First Floor:
Cost of Constructiom'-s-' ra Utilities: _Sewer —Septic, Building; Height:. o
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Name 3_(xLt� e3p e> %
Name:
Address: 16" '5- .Ta0,t1VLtyS -e-'t>
Company:�A�-.. Gun�v ' FcNG�
I__i_C.
City: PLC State:
Zip Code: Fax:
Phone No. -7-7?_ 1-09. 315-2-
Address: 32Z L ®Lj A0t�
City: FijEL �
Zip Code: 3?t9 $Z Fax: 7�2
Phone No -7-?Q_ 2L&--_&aLV7
Stater
4reiL v-01,4,5f
E-Mail:
Fill in -fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail CA soa+[au Raffia=u�iv Couwn-z,�
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State or County License ('CCoS *3
11n2Sq
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.
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,.y.PIEM.ENAI..CO�N•s �R UGTO '�7W-,IN,FOR�?(II:itATtN;t,°:�'
DESIGNER/ENGI'NEER: 'Not Applicable
Name:
`v���Y' �= TS •�``::c �Y�sn
`.:.� ,_, 9 f ?• `
MORTGAGE COMPANY:%, _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 Lu
roperty. A Notice of Commencement must be recorded in the public records of St.
Lucie Co t nd on thejobsite before the first inspection. If yoyy.. to o to financirig;'consult
with le d or anev before commencing work or recordinRwo�rfl tce of Com e�PmPnt.
S—ig'6afdre of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
pSTATE
STATE OF FLORIDA (AJA
OF FLORIDA�Uf'
� 1..�
dCOUNTYOF
COUNTY OF � �
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Phv 1 Presence or Online Notarization
Pf yl is Presence or Online Notarization
/\ by
this y of 2020 by
this a of 20
Name of person making statement. V
Name of person a@ng statement. loor
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identificatio j
�'�� j�
Type of Identification f T,
y
Produced 1./ C/
Produced �-! JJ
(Signature o otary Public S to of Florida)
(Signature of Notary Publi ate of Florida )
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Commission No. (Seal)
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DATE
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RECEIVED
DATE
COMPLETED
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Rev. 5/6/20