HomeMy WebLinkAboutPermit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: %-/q `Z/ Permit Number:
0 �T
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial ReSldential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 7-601
Property Tax ID#: 1-30 /— b 0 (.` 00:_? 00o -Y �
Site Plan Name: o -i'k if_S F
Project Name:
DETAILED DESCRIPTION OF WORK:
a,/"/z-ice's
Lot No.�
Block No.
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
Electric _ Plumbing 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 12-4 �2' .
Name:
Address: fool ifzz
Company:
City: - State:
Zip Code: Fax:
Phone No. 39�- 6 7-Z%2-
Address:
City: State:
Zip Code: Fax:
Phone No
�f6L
E-Mail: r,Alt'
Fill in fee simple Title Holder on next page [ if different
from the Owner listed above)
E-Mail
State or County License
IT value or consiruc[ron is c-,Puu or more, a rctcUxvto 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 -
DESIGN ER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
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.
",/,< c_�
Sig re of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA--
.
COUNTY OF 1 iC
STATE OF FLORIDA
COUNTY OF
Swgrm to (or affirmed) and subscribed before me of
V .physical Presezce or Online Notarization
this dJ day of 51 y
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of 2020 by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Personally Known OR Produced Identification
Type of Identification
Produced
Produced
n`
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No%& '+ 14019f glie State ofFlorida
De r i uebler
Commission No. {Seal)
My Commission GG 928457
Expires 11103/2023
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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