HomeMy WebLinkAboutBUILDING APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: .X \� 1��� Z� Permit Number:
S`1-.Ld UL
E `' I, l '' 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:
PROPOSED IMPROVEMENT LOCATION:
Address: \"90'��A UL-AC-1 L (Z:3`-jcl�Z
Property Ta:S�-A k C1 - I-D Lot No.
Site Plan Name, G - Block No.
Project Name: \ kT1Ci r-� •-e_
DETAILED DESCRIPTION OF WORK:
-t 3
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 Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 1Z Utilities: —Sewer _ Septic Building Height:
O ER/LESSEE:
CONTRACTOR:
Name rdc e--
Addr ss:_ 4 C _L <_
City: U t .-� SV State:
Zip Code: 3�i 1SZ Fax:
Phone No. �ly l .
Company
Addre s:CS-12_C_) Sft
City:kb( k S�A ' �.t-�C_l-'L State: r
Zip Code: J5-ACt C#0 Fax:
�
Phone No
E-Mail:
,
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail C_ G1YY1�d,
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.
iW
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMAT
DESIGNER/ENGINEER:
Name:_
Address:
City:
Zip:
Phon
_ Not Applicable MO AGE COMPANY: — Not Applicable
FEE SIMPLE TITLE HOLDER: _
Name:
Address:
City:
Zip: Php e:
State:
licable
me:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
State:
_Not Applicable
OWNER/ CO ACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify tha o 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
Owner I Signature of Contractor,
STATE OF FLORIFIAII CAC I STATE OF FLORID 1 1 .
COUNTY OF'� l-�COUNTY OFC 1
-5 *n to (or affirmed) and subscribed before me of
Physical Pre nce or Online Notarization
this __-)) day of 2020 by
C�r\
Name of person making statement.
Personally Known`\ OR Produced Identification
Type of Identification
(Signature of Notary Pu cyl a e o 0
ovt' �4� Notary Public State of Flonda
? Ashley DggI Toro
Commission No. . My S&QLtssion HH 052369
Expires 10)11/2024
REVIEWS FRONT I ZONING
COUNTER REVIEW
RECEIVED
DATE
COMPLETED
�vyorn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of 2020 by
Name of person making statement.
Personally Known � OR Produced Identification
Type of Identification
Produced
(Signature of Notary Publi Sta -', F o
io Notary Public State of Flonda
mission No. C3f'rfi My ; Toro
ion HH 052360
or n� Exprres 10/1112024
SUPERVISOR I PLANS I VEGETATION SEA TURTLE MANGROVE
REVIEW I REVIEW I REVIEW REVIEW REVIEW