HomeMy WebLinkAboutBuilding Permit Application, UPDATED, OWNER, BUILDER 2.22.21All 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
Address:
Property Tax ID #:I.2.� ' �cr 5 ' �C• lU -� - % Lot No.
Site Plan Name: ��.�-t 1X _ _ Block No.
Project Name: Z /.Ii /C�Alel
DETAILED DESCRIPTION OF WORK:
New Electrical Meter !t Second Electrical Meter A4 `"� *r �X3� 11��' /!'<<<'N � -
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: %G/� Sq. Ft. of First Floor:
Cost of Construction: $ _=Ci �:L"�-- V/- Utilities: Sewer —Septic Building Height:
OWNER/LESSEE: {��/
.._ �/ Lj/7t�/1��'
CONTRACTOR:
Name - '.4/F /� l.Y` Ole � � G�/.`�
Name: ! .z'4'A6- j--
liE�%,rT
Address: 137.414/ i� e
Company: :i-
City: 1;FV1117 C sK! State: '
Address: %? 77.Z
Zip Code: •3�-f zZ Fax:
�.`�;�k1ic�:;_-�'c'=t`�
City: ;`'hill �irY
State: % !
Phone No. I1 Z' - 77I " 'y�l'
Zip Code: 3 -�ff
Fax:
E-Mail: C-:-z L�<< !
Phone No eill -- iG'
-�' 3=eeQIvC,
Fill in fee simple Title Holder on next page (if different
E-Mail
from the Owner listed above)
State or County License
11 VMIUC VI wnaLIuL.Uuii is coup or more, a Ktwnutu ivotice or commencement is requirea.
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: 11Y, J, C�>, �; -,U
:. '�> S t'F•
Address:
—
City: ; y`� .•Y�f
State:
Zip: 1.i�; Phone
-� - - -
FEE SIMPLE TITLE HOLDER:
Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address: _
City: State:
Zip: Phone:
BONDING COMPANY: iNot Applicable
Name:_
Address:
City:_
Zip:
Phone:
UWNER/ 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 our Notice of Commencement.
Signature of Owner/ Lessee/Contractoras Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA t STATE OF FLORIDA
COUNTY OF COUNTY OF
Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
his
ysical Presence or Online Notarization Physical Presence or Online Notarization
tday of `L, �'tT, 2020 by this _ day of _ 2020 by
tLa�c� V1e� n Ir
Name of person making statem nt. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Pro cecl Produced
(Signature of Nota Public- State of FI f Notary Public- State of Florida )
,`4rt9." SHIRLEYA. AONIER
Commission No. i i(A cTt oZ MYCOMMISSIOt k tNf,R§Qio No. (Seal)
EXPIRES:,lanu iry31,2025
Bonded Thru Notary F iblic Underw itars
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20