HomeMy WebLinkAboutBuilding_Permit_ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 4 � Z� 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
PERMIT APPLICATION FOR:
Haaress: ill I 1 J CX-�A 4 Dll j' 7_ Club Property Tax ID #: 'L{S/ 1 -' 5-1O I ® O 106 -- oco Lot No. G 06
Site Plan Name:
Project Name: _
S S VK R 2-c> 2_
u,PF'04 hN b :VW S-FALL I'ktr i7FL Roc Gr tit G, $ VSTev►t
New Electrical Meter Second Electrical Meter
Block No.
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 /Z Pitch
Total Sq. Ft of Construction: ! Zc�rn Sq. Ft. of First Floor:
Cost of Construction: $ g zzz- , coo Utilities: —Sewer _ Septic Building Height: to
C
Name Name:: RtEAcTr4 (=✓f}-t-i fS
Address: ZA 42_5'llon- 2Ij Company: t;-;P6 6&'-%-cPJ -Luc
City: Pc2T' -:;I- State: Address: I tSo AE11-- All
Zip Code: 34otS2- Fax: City: FT- Pkt;7(Lc-E- State: FL
Phone No. 7'7 Z _";7C) Zip Code: 3 Lri 9 L_ Fax:
E-Mail: 6tl(so-:0 wet- Phone No 1-12- 33Z gto0
Fill in fee simple Title Holder on next page ( if different E-Mail_ I* eQ (- 4 r o%..D % Cz A-1
from the Owner listed above) State or County License CCC.- L 3 3 1 q L7Z
If value of construction is 2500 or more a RFroRncn nb,*:, e s r,........___ y__a ___
---__---, _ " - ....•...c v. � - uncn%.C111errl IS required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
;
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 Recor# 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 Aof Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF St r.,&-r-t C Co COUNTY OF S7'" Lcc cr t= cv
S rn to (or affirmed) and subscribed before me of
Physical Presence or
this 14 day of 2020 by
Name of person making statement.
Sworn to (or affirmed) and subscribed before me of
- Physical Presence or at4en
this Lft``day of F¢5r"11r*-p 2020 by
[' 1 G� � K C� v�C •L S
Name of person making statement.
Personan'yKnown OR Produced Identification ersonally Kno OR Produced Identification
Type of Identification
Produced en i ication
,,S,Sm 1111111111/you ProducedG.
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�� G ,•oMMtssiati'•, '9 � - � •,���� 30 vfkA;•,
(Si f otary Public- Statef Flogda *), �►• �s •: *_(Sign Wary Public- State of Florida
ion ` 9N n Z c� %SR IX #GG340204 mission NG 3�fo ?�% m0
REVIEWS I FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
VISOR PLANS I VEGETATION I SEA TURTLE I MAI A15
REVIEW REVIEW REVIEW REVIEW REVIEW