HomeMy WebLinkAboutST LUCIE permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
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:
f PROPOSED IMPROVEMENT LOCATION: l9�, �::r3�r�v�rrv�.►�,rr,
Address
A
� LociQ r
0
Property Tax IQ#: �4I �_j _ ,5 3 0 Q2-SS 2- 00 � Lot No.�
Site Plan Name: Block No. ��-
Project Name:
DETAILED DESCRIPTION OF WORK:
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 T Windows/Doors Pond
Electric Plumbing Sprinklers _ Generator Roofs Z Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: _ Sewer — Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 0
Name: TIr
Address: i' I I
Company: e .•1 /26D
City: i• pi t- t e. State: _LZ
Zip Code: ' 5 Fax:
Phone No. (j) � �
Address: I i q j
City: e]r� Stater
Zip Code: q,-1 _ l" Fax: IIII
Phone No 23 0�' ZyG
E-Mail F' C�{�r�r.uG •¢ G �zrq ��
E-Mail:
Fill in fee simple Title Holder on next page if different
from the owner listed above]
State or County License
It value of construction is Z500 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.
1 5UPPLEMENITAL CONSTRUCTION LIEN LAW INFORMATION: I
DESIGNER/ENGINEER: — Not Applicable
Name:_
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:_
State
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:_
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 wi11 authorize the ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or an9covenants 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 bulid Ing permit applications are exempt from undergoing a fu11 concurrency review: room additions,
accessory structures, swimming pools, fences, wa11s, 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 inspect' n. If you intend to obtain financing, consult
with leader o an a ttorneybefore commencin g work or reco i ng-jj4urN owce of Commencement.
Signature fif Owner/ Le e/Contractor as Agent for Owner
S' a re of nt act r/License Holder
STATE OF FLORIDA
STATE 6F FLORIDA
COUNTY OF
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
V Physical Presence or Online Notarization
V'� Physicai Presence or Online Notarization
this 1/— day of �� 2020 by
this day of -hf/i 202 f by
Name of person making statement.
Name d person making statement.
Personally Known as OR Produced Identification
Personally Known V' OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
{Signature of Notary
(Signature of Notary Public- tat��lo s
g y k PubliC State of Florida
o.►�} • Notary Public Sate v' =:06da
?� Wilner Beauchamp
Commission NO. = vvilner 8 �r Trip
230F380
* M mission GG 230860
Commission NO. y
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