HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
0
7 0 D Building 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: � � i, t—k
PROPOSED ILI/1PROVEMENTLOCATION:
Address: �)q (IL ()a'afl uft. L.
Property Tax I D#: 3�j� - �� ' U C1 oc-)o- 0 Lot No.�
Site Plan Name, Rivtr foil-11L- Ulu t - C-[ JbLIL Ls i I I 39)d- IS Block No. 3 r j
Project Name:
[DETAILED DESCRIPTION OF WORK:
'i'C,I,L I S}S �( R C if (�,CLX. S teL_c I S+Q') e
New Electrical Meter Second Electrical Meter
. .CONSTRUCTION INFORMATION: _
Additional work to be performed under this permit-check all that apply:
Mechanical —Gas Tank Gas Piping Shutters Windows/Doors Pond
w Electric _Plumbing
r _Sprinklers _Generator je<Roof �C7�—Pitch
Total Sq. Ft of Construction: + Sq. Ft. of First Floor:
Cost of Construction: $. J E oZ� . L Utilities: _Sewer —Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name �iqc'j L t-'4 Ck.^n -S Name:
Address: 131 n Company: St LL P I'Let
City: 31 SJ ;c State:l-1 Address: Gj 1' S SuWb ",' Q da 13) 061
Zip Code:'t/.c/F�) Fax: City: Kvk SA- State: (1
Phone No. 40CCf - (�) Zip Code: 3197"1 Fax:
E-Mail: Phone No 1 )-- 3 Y Y _ -7 1913
Fill in fee simple Title Holder on next page( if different E-Mail TCf-(-, 'SCK-Ce_ CMo, 1, Cn
from the Owner listed above) State or County License ecC I 33U�fl j L41
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION:
DESIGNER/ENGINEER: , Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Prone 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.
1 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 wiil 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 recor ing your Notice of Commencement.
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1
Signature of Owne /Le eea_ C tractor as Agent for Owner Signature of Contra 'or/ "c se Holder
STATE OF FLORIDA STATE OF FLORIDA ST '
COUNTY OF � �. LA 0"i COUNTY OF
S75wo n to(or affirmed) and subscribed before me of Swgr-n to(or affirmed)and subscribed before me of
Physical Prese ce or Online Notarization V Physical Presence or Online Notarization
this day of J ck t"1 2020 by this LC
t day of J4A J 2020 by
Name of person maki g statement_ I Name of person making statement, I
Personally Known if OR Produced Identification Personally Known '/ OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public-!State of Florida } (Signature of Notary Public-State of Florida)
Commission Na. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
C CONSTANCE ROULX '
ReV 9 z rate o Ari a-Notary Public
-2 State of Florida I�fltary Public -. Commission #i GG 258323
*=_ Commission # GG 25$328 s
? F oR My Commission Expires
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