HomeMy WebLinkAboutBuilding Permit Application C
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �" I �'' Permit Number:
R
�o RECEIVED
O
JAN 12 2021
Building Permit Application
Permittin epartmdnt
Planning and Development Services st. de Caurfty +
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: p \vim
Address:
Property Tax ID
Site Plan Name: Block No.
Project Name:
pg
~DET9 QED DESCR TI®'N O IK: `-
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New Electrical Meter Second Electrical Meter
i s.�.r,•��'-tom ,� ` ���`.'�..^�" � F i-- "`- °.:, �. -�. �- - �,a -.� ..
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors _Pon
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$41, ee Utilities: —Sewer `Septic Building Height:
0111/NER%LESS ` t X i "C)'NT CTO'R W.
IN.
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Nam : '1 <O¢J c- Aj
Address: dd,y' 1(r�/� LJ l��t Cotes
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F e N� r3/US C 0/U /a-f
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Zip Code: '3lgS Fax: Ci : (f State:
Phone No. 77G �3 CEO Zip am Fax:
E-Mail u Phone o 7�
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License
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.
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 commencing work or recording our Notice of Commencement.
Sig ture of Owner/Lessee/Contractor Agent f r Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ,-.-- [ A a cle COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presen_!S Online Nota ization Physical Presence or Online Notarization
this 4-day of 0;P I� 202 b this day of ,2020 by
Name of person making statement. J Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificatio Type of Identification
Produced Produced
(Signature of Notary Public/Wto Ida) (Signature of Notary Public-State of Florida)
`\�aOtAHYpG� -
Commission No. =HSe Commission No. (Seal)
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REVIEWS FRONT ZO � � P,Fe 9IS u lip NS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW /to VIEW REVIEW REVIEW REVIEW
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