HomeMy WebLinkAboutBuilding Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
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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
I PERMIT APPLICATION FOR: K tCh ac� C_�n
Address: TQ -_�?
0 (�) � � (,�, (�)(-
', j U01
Property Tax ID #: 123 - Q31-2 -000-
Site Plan Namer?v-)
hLE",v - u):l H m� R - un__
(> New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit- check all that apply:
,\Mechanical Gas Tank —Gas Piping Shutters
X Electric — Plumbing — Sprinklers
Total Sq. Ft of Construction:
Generator
Sq. Ft. of First Floor:
Cost of Construction: $ <5 ) IN , 3 5- Utilities:
Name
Address: �_V
City: - PC) 'u State: 'R_
Zip Code: Fax:
Phone No.n4l?
E-Mail: P\4 Pr
Fill infee simple Title Holder on next page (if different
from the Owner listed above)
Windows/Doors
3___
Lot No.
Block No. L40
Sewer _ Septic Building Height:
Pond
Pitch
Name: 'ZTOVA Y--! q-
Company: - (12,uv- E�e-cic\e- 2a'� P�-'r
Address: (-O't ) S(AS _c�()L>L MCILL4L
State: T-�L_
Zip Cod4 9 & H Fax: 19 0 -1
Phone No -3 _� -�T() -- - -:-
E-Mail 14�e e (OAA
State or County License (AC_1�51V_63
-- VQIUCVI %.VOIDLIULLIVI I no Law ur more, a Ktk.VKUtU 11YOXICe OTLommencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
5l1PPLEMENTAL CONSTRUC'fION.'LIEiU LAW IN�ORMATON:
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.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor // ice, Holder
STATE OF FLORIDA
COUNTY OF
STATE OF FLORIDA °`�
,-
COUNTY OF 4 o
Sworn to (or affirmed) and subscribed before me of
--Physical Presence
Sworn to (or affirmed) and subscribed before me of
or Online Notarization
this " "day of _ '~2020 by
Ph sical Presence or Online Notarization
this, 0day of a 2p20 by
Name of person making statement.
Name of person making statement.
Personally Known ><OR Produced Identification
Personally Known I OR Produced Identification
Type of Identification
T of Identification
Produced rt —
m KONNI LENAE DEWI
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•. State of FI
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Notary Public—
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15 KONNI LENAE DEWI
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Nlmry StateofFori
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(Signature of Notary Public- Stat aN P.4y Comm. xpues
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Aig ature of Notary Public- State )` Commission # GG 1 6
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