HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TQ 6E ACCEPTED
Date: Permit Number•_ l 0_ --
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fuildling �'urnit�eppffe' I 1
Planning and Development Services
Building and Codeliegulation-Division Commercial �_ Residentiarkdo'''�r
2300✓irginia Avenue,Fait Pierce FL 3,1982
Phone:(772)462-1553 Fax:(772)462-1578
PEltiI'Vil'a AIzPLCCACE(Qft FOR: Keujn~Hgrt'15
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Address: �dq � �161 �1192r Dr— F-I- �Peme 3490L
Property Tax ID#: 1 '0004— ^I00 D Lot No.
Site Plan Name: —' Block No.
Project Name-
I /`-ram
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sll e W=inarical'meter Second Elcarical Meter
LCOiU�TRUCTION l'NFORMATION: 3
Additional work to be performed under this permit—check all that apply:
__Mechanical _(3as Tank Gas Pii;lng, Shutters (Windo,vs/Doors Pond
Electric _Plumbing —Sprinklers Generator _Roof Pitch
Total S^.Ft Of.COnStriict;-n _ _: _.__._.. Sq. Ft. of Fi.."t Floor'
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Cost of Construction:-$ / I/ aD y� 0i) Utilities: _Sewer ,Septic Building.Height:
n�tirniroll ecctr _�_� �__ rnnrrat.r„r�r�
Name—Kf Ul (1 m_e, Name:
Address: letn QIU2r DL Company: --
city: Ft Slater-_. Address:
Zip Code: 3�rlb2-' Fax: City: State:
Phone No. �1. •�_ r w_ :I�n12 - - - Zip Code:._ Fax:._Y . ._----
E-Mail: KtClr-rIS �w �21��U . Y� _ Phone No
Fill.in fee sirnple!Title Holde' r on neat page(if different E-Mail
St att,-or 1.€4iFnty LIc-C
If value of construction is 2500 or more,a RECORDED Notice of Cornmencernegt is:required.,
If value of HAVC is$7,500 or more,a RECORDED Notice of Coitimencement is requircd.
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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 obtain financing, consult
with lender or an attorney before-commencingwork or recording our Notice of Commencement.
Signature Af Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STAI E OF rLORIDA i�St�4� COUNTY OFSTATE OF ORIDA
COUNTY OF �
Sworn to(or affirmed)and subscribed before Pie of Svforn to(or affirmed)and subscribed before mo..of
Plti 'eal Pres:rice or online NotarizaliUn Physical presenc:c 01' Online[krotarization
this 16 day of 7 cl n .2020 by this day of 2020 by
mameof person makingsatement. Name of person making statement.
Personally Known OR Produced Identification Personally Knoirm. OR Produced.ldenti ication
Type of Idesitificatir,p { Type of Identification
Produced I` 1i Produced— - .--- ---- --- ----__
(Signature Lary fro; iy (Signature of-Notary'Pub!ic-State of Florida)
My C i�8jde (�G,
Commission No. o°�O' ��5 on c ark o bi/c Commission.No. (Seal)
REVIEWS FR0MT ZONING Sul . R PLANS V.EGET!1TIOM SEA TURTLE MANGROVE
COUNTER REVIEW REVIE REVIEW REVIEW REVIEW REVIEW
DATE ---
RECEIVED
DA L
COMPLETE6
ev.