HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: If - 00- a2,Z2 Permit Number: & 0ta 'qD(D0I
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° ` Building pp Permit Application
Planning and Development Services .
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:
Address:
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Property Tax ID #: o(�`/ % 6 ®�" 0d 60— O00/0 Lot No.
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New Electrical Meter Second Electrical Meter
I'._ r h , rry , •., s 4,� .�, '� f '.` a( p1"'t .r, fip" Y 7�. ,g,'�
c'.CONSTRUC-�TION �I�I�FOREM�ATI�ON, , �� � s� ` r i � � a s .� r•�
Ad3ional work to be performed under this permit —.check all that apply: —
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors Pond
Electric B/)Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: 4 Sq. Ft. of First Floor:
Cost`of Construction: $ 50 Utilities: (� Sewer d Septic Building Height:
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a ry
CONTRACTOR
DOWNER/LESSEE` { ;
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Name
Name:l'ter»
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Coman ll�d
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CStaterC'Fax:
TLAdress:itv
iliy: State:L
Zdipd;Creosd:e<75�
Phone No.
Zip Code --11� Fax?
Phone No-7-72, /�?21— �J-
E-Mail:
Fill in fee simple Title Holder on next page (if different
E-Mail ?_Iq
from the owner listed above)
State or County License i W11 2 j 3�
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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DESIGNER/ENGINEER: Not Applicable -MORTGAGE COMPANY: — Not Applicable
Name: Name:
Address: �5Address:
®r� S /vc �'� State: G City: State:
City:
Zip: Phone 7 72)c;/8 — �qG `/ y 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 CountyLmakes no representation that is granting a permit will authorize the permit holder to build the subject structure
tructurenPleasle eonlsult 1nNyith your Home 0 Owners
Association and review bylaws
r deed for any restrict that
which may apply Ibit such
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: Yourfailure 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 1'ender or an attorney before commencing work or recording your Notice of Commencement.
re
as Agent for Owner
STATE OF FLORIDA /
COUNTY OF 2� &/e:fZ � -
(or affirmed) and subscribed before me of
sical Presence or . Online Notarization
day of 422 , 2020 by
Na"'01.elof person making statement.
Personally Known ,/ OR Produced Identification
Type f Identification
P� P
(Si ature of of y li tate of Florida )
Commission No.
REVIEWS I FRONT
COUNTER
DATE
RECEIVED
DATE
COMPLETED
:ure nt or a Holder
STATE OF FLORID
COUNTY OF 5 r, G
1 to (or affirmed) and subscribed before me of
Physical Presence oronlineNotarization
Lffday of Z:2g 2020 by
Name of person making statement.
Pe IOI,nally Known OR Produced Identification
Typeof Identification
Produced
( nature of otary P lic- State of Florida )
�Sf� §q)ROMEROZEf.AYA I Commission No.
N tary Public -State of Florida
Commission s GG 208712
TATI
REEVIE NI G S RPE VIEW I REVIEW PLANS I V GE EWON
(�I ROMERO ZELAYA
Ndtary Pu lic - Statc of Florida
Commission 4 GG 208712
M Corm. Ex ires r IS.02
fed thtou h National Notary Assn.
REVIEW I REVIEW