HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUS7
BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
OT. LMQ�I
0
P r
Building Permit Application
Planning and Developments
vices
Building and Code Regulation
Division Commercial Residential_
2300 Virginia Avenue, Fort Pierce
FL 34982
Phone: (772) 462-1553 Fax:
(772) 462-1578
PERMITAPPLICATIO
FOR:
PROPOSED IMPROVE
ENT LOCATION:
L I'i
Address: o
Property Tax ID p:
_ ,.�� _
Site Plan Name: \
Lot No.
ICR
- -
Block No. ^�fl.h
Project Name:
Ci,
DETAILED DESCRIPTI
N OF WORK:» -
New Electrical Meter
Second Electrical Meter
CONSTRUCTION INFO
Additional work to be performed
under this permit -check all that apply:
Mechanical _Ga
Tank _Gas Piping _Shutters _Windows/Doors
Electric _ Plumbing
_Pond
_ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction:$
_ Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name o \or
_
t�C, Name: dd) 14\&fg
Address: CJ dl tK,
p�
Company: QtOK%NoM1
City:
State: �(. Address: lq0 .J Comm !rP Q)t 3
Zip Code: 3y9P I
.SQ(;11Jk ,5.1;1�
Fax: City: 6)LL,(ct� State:
Phone No. - b -
Zip Code: 3.m Fax:
E-Mail:
s GkG Phone No�p�41,-DO- 4ILL
Fill in fee simple Title Holdei
on next page ( if different E-Mail {s�IG ,C� Sd K win
from the Owner listed above)
Qcm,
State or County License_/'. 1,JC0\(a
d value of construction'* 2S00 or
more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or mxne,
a RECORDED Notice of Commencement is required.
SUPPLEMENTALCON
TRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Address:
City
Zip: Phone
Not Applicable
_
MORTGAGE COMPANY: Not Applicable
Name:
Address:
State:_
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDEI
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
. ; �..r wr.,rv�a.ivn wr
certify that no work or installation
ur
fusn is Appucanon is Hereby made to obtain a permit to do the work and installation as indicated.
has commenced prior to the issuance of a permit.
St. Lucie Coun makes no repre
which is in conflict with any applicable
ntation that is granting a permit will authorize the permit holder to build the subject structure
Home Owners Association rules, bylaws or and covenants that may restrict or such
structure. Please consult wrath yo
prohibit
r Home Owners Association and review your deed for any restrictions which may apply.
In consideration ofthe granting c
f 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 1
iods, fences, walls,signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: You
r failure to Record a Notice of Commencement may result in paying twice for
improvements to your 1
Lucie County and posted
iroperty. A Notice of Commencement must be recorded in the public records of St.
on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney
before commencin work or recordin N f
ootice o Commencement.
gnature of Owner/Lessee/Contractor
as Agent for Owner
g atur�ctor/License Holder
STATE OF FLORID
STATE OF FLORIDA
COUNTY OF \I U.
Cl,
COUNTY OFy OluSrt fi
Sworn to (or affirmed) and sub
SX P Ical Presen or
` say
cribed before me of
Online Notarization
Sw rn to (or affirmed) and subscribed before me of
sical Pre o Online Notarization
this of
2020 by
this day of �, 2020 by
I
Pi
Name of person maki/ngg statein
nt.
Name of person ma'ki/n�g state ment.
Personally Known OR
Type of ldentificatio
roduced Identification _
Personally Known w OR Produced Identification
Type of ldentifca on
Produced
Produced
r5ignaturijof N o
I �gnature I
hryfx/Vyy
..Mr� N
Commission No. I D
ry P.M. Sbh of Fbrga
ryl R BrakRa..�-
N� ryPubl¢31andF�orMa
Daryl R Brake
Him niNIA32515
Commission N ��((ppaalI11
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rtas 11/1712023
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'ar Exprea l I..n G3
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
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