HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED y�
Date: Permit Number:(1� X0010
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential J
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772) 462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
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Property Tax ID#:J 2 0 ti— �S - a33� d 1 Lot No.
Site Plan Name: Block No.
Project Name:
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New Electrical Meter Second Electrical Meter
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Additional work to be performed under this permit—check all that apply:
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_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Pond
Electric _Plumbing _Sprinklers :'_:Gen'erator• -Roof Pitch
Total Sq. Ft of Construction: ri Sq' Ft. of.First Floor:
Cost of Construction:$ ��� Utilities: 1. Sewer _Septic Building Height: _
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OWNER/sL�ESSEsE� a+ ;�� w,�wx, _� t "4 � �
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Name -n MY Name h
Address: fit It T ' •Company:
City: (I- State: Address:
Zip Code: ,rFax: City:, State:
Phone No. ��I '`IiJZ"�q°l� Zip Code: Fax:
E-Mail: CCA rv—I C M 0n f 2 I .Cm/r Phone No
Fill in fee simple Title Holder on next pa de(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.
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DESIGNER/ENGINEER: i 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 Counter 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 recordin our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORI4 A STATE OF FLORIDA
COUNTY OF. ,51. LVG. COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed) and su cribed before me of
Physical Presence or Online Notarization Physical Presence or Online Notarization
this 41 day of 202� by this day of 2020 by
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Name of person making statement. o N a' Name of person aking statement.
VI w ;N A
Personally Known ✓ OR Produced Identific i °N z Personally own OR Produced Identification
Type of Identification Type of I ntification
L N 3i C
Prod ed W ='a Produc d
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tur of Not Public-State of Florida (Signature of Notary Public-State of Floridaission No. 3 (� (Seal) :a>:`C ,
3 Commission No. (Seal)
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.516120