HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED d
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Date: Permit Number:
0
RECEIVED
91ro WOE w
0
DEC 21 1010
p ` °` -° :.�... , Building Permit Application
Permitting Department
Planning and Development Services
St. Lucl ounty
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: �dr1S�fUG �Vl .['it117��
,PROPOSED IMPROVEMENT LOCATION. -
Address:
SZ
Property Tax ID#: 3--t)006 `®J)O
Lot No.
Site Plan Name: 6o Act-&,&
Block No.
`s6
Project Name: W(1JV0,_ �t�«�►/�
DETAILED DESCRIPTION' OF WORK:
I
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 6I1)% 12— Pitch
Total Sq. Ft of Construction: _ S0040 Sq. Ft. of First Floor:
Cost of Construction: $ 3_0_01Qeaex) Utilities:. —Sewer —Septic Building Height: 30
OWNERAESSEE:
CONTRACTOR:
Name
Name:
Address: 161 SE__('
City: 6 4- hLvt _ State_
Zip Code:.�t4gS;-2 �. Fax:7TZ''���� �q3
Phone No.777-7-
Company: u t
Addr s: I'� u
City: 'Quez C42- State:
Zip Code: Fax:77L -336950t4 r--..
E-Mail: W,
Phone No 77z.-2!0Ch6
E-Mail `
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Fill in fee simple Title Holder on next page ( if different
State or County License
from the Owner listed above)
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.
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W.
a MENTAL CONSTRUCTION`§LI,EN LAW INF'ORIVIATIO:N
SUPPLE � .....: � r ,.
... : , .
DESIGN ER/ENQ INEER:
_ Not Applicable
MORTGAGE COMPANY: > Not Applicable
Name: \L
Name:
Address:
Address: Q. a%&—
City:
State:
City: State:
Zip:3ylqso hone
— z4
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
� 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 your Notice of Commencement.
Signature of Contractor/License Holder
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA 1 -
L�,�
STATE OF FLORIDAt ,
�UCI�
COUNTY OFF W►3
COUNTY OF �t�
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Pr ence or Online Notarization
thisZk day 2020 by
Physical Presence or Online Notarization
this Ti l day of D2��, 2020 by
of
NX�el u ram. `_aar Gg^
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Name of rson making statement.
Name o rson making statement.
v
y
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identificati n
Produced
Type of Identification
Produced
IX '
(Signature of tary Public- Stat
Pie
Si nature of Notary P blic- State o F r'
r i►�� SANDY KELLEHER
Zr. to Public State ofFl
Commission N�. e�l� ry
k GG 9642
ri a ����'ss I��,,[['��7p ,�'"r'�"' SAND ELLEG
1 �o mi�sio►`f! // 4''' ''//�
.� Commission
'?oF My Comm. Expires Feb 6,
Notary PublPc��,1da
023 Commission it G23
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