HomeMy WebLinkAboutBuilding Permit (corrected)All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �✓ /
Date: Permit Number: I
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:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax R
Site Plan Name
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter it U ,I ,4 Second Electrical Meter n y Ll
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 0" 2 e oa, on
_ Generator
Sq. Ft. of First Floor:
_ Windows/Doors _ Pond
Roof Pitch
Utilities: _ Sewer _ Septic Building Height:
OWNERAESSEE:
Namew,ga d DW'wn ' t YJtAL Wnerr
Address: 1 3bQb J IVDIAN RIVER DR ''
City: JENSEN BEACH State: FL
Zip Code: 34G5,7 Fax:
Phone No, 772-777-9940
E-Mail: SUPERGLASSFL@amail.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Company:.
r4m
City: / I / State: -1, 1
Zip Code: qq// Fax: 77
Phone No L -' 2 -63 4--7 6 c
E-Mail L-e-00u —G S' T got, Ge)"
State or County License 0 3 1 !0 J
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 LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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.
L snakes no rel.:::sentatfon + , is gra n s nL_ , f :nit will authorize the permit holder to build the subject structure
which fs urywnf t .tn any applicable Home owners Associaton 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 ob in financing, consult
with lender or an attorney before commencing work or recording our Notice of ComVnencement.
Signature of Owner/ L Ts/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA //
STATE OF FLORIDA
COUNTY OF S 4 L+n C'
COUNTY OF t✓I '1 n
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Notarization
Physical Presence or Online Notarization
_Online
this 'I, I_ day of raP Ce w l_-9- —, 2020 by
_,,j
this —a— day of 2020 by
DhS, L tL,U
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known V OR Produced Identification
Type of Identification
Type of Identification
Produced (r LL
--a
Produced *,
E L.JpyF
�fp��l1
(Signature of Nota y, `'`:State ftftl idm$EPH
(Signa ure of Notary Publ - St to lo.1
y• Notary Public - State of Florida
Commission 5040
Commission No.?ovti` f5
—^----MyEvmm. Expi es a 3, 2022
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Commission No. Seir���ts r; Q
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REVIEWS
FRONT
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SUPERVISOR
PLANS
VEGETATION
SEA TUR �f
�jj10Ti�VE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
EVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.5/6/20
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