HomeMy WebLinkAboutBuilding Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
1, LUcic
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: P_Qi_cx.,-r(-
PROPOSED IMPROVEMENT LOCATION:
Address: 1103 U`1
Property Tax ID #: 3LjOL- • eZ6 ° C0I d • CCXD •z.- Lot No. ) 0
Site Plan Name: Block No.
Project Name: 15V Qk-
` DETAILED DESCRIPTION OF WORK:-F.(off � � irr,4 (JCC')r-),AD O`, oo06! CA-
JvAW Iw6edau.mouA, 4o ct:xde_ PffAAII U 146,4)" 4y cote L4,,41 c�wp
-bCaje, &_ V rr a1 s 15 VM cede.
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
Electric _Plumbing _Sprinklers
Total Sq. Ft of Construction: 3 &32-
Cost of Construction: $ -L5 f /00, 00
Shutters Windows/ Doors Pond
_ Generator Roof 5 i 2 Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name e,bea1a m oltP.-r
Address:_ lj()3, JtL) (r_L Lfo
City: a DIQYLt State: c�Q
Zip Code:' e>2- Fax:
Phone No.
Name: n
Company: c�
Address:_
City:
Zip Code: t'�401S Z-
Phone No _-I-�TZ
E-Mail 'a)
State:
Fax: U
Z.+l_Q
, C-(z ro
E-Mail:
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Narne:_
Address:
City:_
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 attornev before commencing work or recording vour Notice of Commencement.
Signature of Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Swor (or affirmed) and subscribed before me of
Ph6, ical Prese ce or Online Notarization
this day of,� 2020 by
P�6e-c-co'--M k�nni ..lQ_. __-;'
Name of person making statement.
Personally Known OR Produced Identification
(Signature of Notary Puohc} State of Florida )
Commission No. t� Flo NW$tM901F1orWa
Pamela Jones
tcv, AN My commission GG 985470
REVIEWS VIS CO OFROAT - — 170171
REVIEWDMG "� RETJ VIEW
DATE
RECEIVED
DATE
COMPLETED
of Confr-aelorfLicense Holder
STATE OF FLORIDA (--,) ULe-tt�
COUNTY OF �J'
Sworn (or affirmed) and subscribed before me of
Phial Pre nc or Online Notarization
thisy day of �Q e� ✓_, 2020 by
Name o person making state ent.
Personally Known &" OR Produced Identification
Type entification
Pr oduced I
(Signature of Notary Public-- State of Florida )
Commission No. �� P - ! �% ioubik State a
�' Pamela Jones
I Al