HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE rFO UST BE COMPLETED FOR APPLICATION-TO BE ACCEPTED In�
Date: '2 ��0 Permit Number:
1J ll o LL UME
� - - ° = 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:
RPQSED I PRa EM NT lOCAT�N:
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Address:Property Tax ID#: 31E R� /n I I
24'1-7 Lot No.
Site Plan Name: Block No.
Project Name:
D AHED 9,M3 +IPTIO: tA}F V!/URK•
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1 cr �P e,4r At
New Electrical Meter Second Electrical Meter
CC?NST� UCTIC+}N INFORII/IATIC?
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Door's` _Pond
Electric _Plumbing _Sprinklers _Generator'':.f 'w Roof y."Pitch.. '.
Total Sq. Ft of Construction: i Sq. Ft. of First Floor:
Cost of Construction:$`N . 1 Utilities: _Sewer _Septic Building Height:'
QWNER/L�S� �E: CONTRA � R:
Name /►1/I l et Q I°4Name: �.. .
s��.
Address: pirio of C cr Company:
City: oi(� L4 Gj { State: F L Address:
Zip Code: SoZ Fax: 6 City: State:
Phone No`../, 3 7 S S' _3 0 ! 9 Zip Code: Fax:
E-Mail: y 1 m61So ol-0 0 ahaq 'G/l Phone No
.Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
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.
'U'F EME�NTA CONST' UCTICIN Ck N LAW IN'F0 ,+MATZO
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: of Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE.HOLDER: Not Applicable BONDING COMPANY: looNot 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 buiid 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 twill,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. sted on the site before the first inspection. If you,intend to obtain financing, consult
with lender or attorne' b re commencingwork or recording our Notice'of Commencement.
Signatur wner/Lesse ontractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA, STATE OF FLORIDA
COUNTY OF \uAL,_Q_ COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Pr sence or Online Notarization Physical Presence or Online Notarization
this�+J day of n 2020 by this day of 2020 by
Name of person making statement. U Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced
(Si natu e o otary PubJig . > (Signature of Notary Public-State of Florida)
y�: LASH.4H INGRAIh_RgHP�11NG
ommission No. =*: *_ P�iY�`tj�SS101�'#GG275060 ommission No. (Seal)
'yjFos F�oP a EXPIRES:December 20,2022
" uDlic Underwiters
REVIEWS FRONT ZONING SUPER " PLANS VEGETATION SEATURTLE MANGROVE
COUNTER . REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.