HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �Q
Date: _ _ '- � - l Permit Number: O� lub" 0
_1 0*40"1 to 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:
PROPO „ SED."IMPROVEMENT LOCATION:
Address: _ 1 O6 r o-,u 4
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name: J 1 L� R-_-, A'3
DETAILED DESCRIPTION OF UV,ORK
(Za-oleirv_ P,,--QJ , �2. �-b+ C6rrA 16 -):
New Electrical Meter ;/ Second Electrical Meter
J,'tONST'kJCTION. INFORMATION: �
Additional work to be performed under this permit- check all that apply:
_lylechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: �C'C)o Sq. Ft. of First Floor:
Cost of Construction: $ f U' 0 Utilities: _Sewer —Septic Building Height:
,OWNER/LESSEE: , .
CONTRACTOR
.
. ,-, Name ►. vV\ � u
Name: j -�ai (�tn�u►,�►�'cst , I c� c�wc Etel , R C,
Address: j%Uy 5r,.,; ace. ��r
Company: M .a �4
�F
Address: IZ29 nC-- Q 0%
City: IFc,C-ir LuCkV__ State: El
City: C14. , (C1� State:
Zip Code: 34d� 2_ Fax:
Phone No. % 7 2 ~ 63 / - Rh Z,5
Zip Code: 3 ` '1 S 2_ Fax:
E-Mail:
Phone No r6, 1 S 1
E-Mail � 1 t_,I-C .Jr,, fIVInQ, C O0
Fill in fee simple Title Holder on next page (if different
State or County LicenseJec t.3 oo 4 t ?,'2-
from the Owner listed alcove)
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 IN,FO,RMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 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/ Lessee/Controor as
STATE OF FLORIDA
COUNTY OF
Sworn 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 Public- State of Florida )
Commission No. (Seal)
I�
Signatu of Contractor n Ider
STATE OF FLORIDA
COUNTY OF S-� LULL
Sworn to (or affirmed) and subscribed before me of
k Physical Presence or Online Notarization
this �S day of FtLo 2020 by
f)Q-\-'M- &or\7-MIeZ
Name of person making statement.
Personally Known OR Produced Identification X
Type of Identification otAY: �e� BRADEN GERC
Produced �-pL, a * Commission #HH(
1 N, ae Expires November
9rFOFF Q\ BondedTlwBudget NOW
(Signature of Notary Public- State of Florida )
Commission No. 91-672. (Seal)
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Rev. 5/b/20