HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
�at€ ) Paz ° �l�i• Permit Number: ) • ps
�o �7�D� —y RECEIVED
�1 :: c DEC' 2 3 2020
Building Permit Application ,Permitting Departmen
Planning and Development Services St. Lytle Cggnb/
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 LO ATION
Address:aZ
®-�' +
Property Tax ID #: 2 �/ ®�d
Site Plan Name:
Project Name:
New Electrical Meter Second Electrical Meter
-CONSTRUCTION INFORMATION5
Lot No. W / 11
Block No. _ 7
Additional work to be performed under this permit— check all that apply:
&4echanical _ Gas Tank —Gas Piping _ Shutters Windows/D 0V1_
Pond
6,61"ectric _!�ZAumbing _Sprinklers Generator Pitch
Pitch
Total Sq. Ft of Construction: ° _ _ Sq. Ft. of First Floor:
Cost of Construction: $ ��iQOD Utilities:wer Building Height:
01NNER%LE SEE.
CONTRACTOR .- .
Name
Name:
Address: -�
Company:
City: z tate:
Address:
Zip Code: Fax:
City: State:
Phone No. — ��
Zip Code: Fax:
E-Mail:/ L 6
Phone No
E-Mail
Fill in fee si ple 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.
SUPpLM;ENTAL.CONSTRUCTION II LAW INFORMATION:
ESIGNERG
INEER:
N t Applicable
MORTGAGE COMPANY: Applicable
Name: .�
u,—r�
n.
_Not
Name:
Address:
_'
Address:
City:
/ 'e
State:
City: State:
Zip:
Phone
'%67.
Zip: Phone:,
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
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 anq posted on the jobsite before the first inspection. If you, intend to obtain financing, consult
with lender 2r6yi attorney before commencing work or recording your Notice of Commencement.
as Agent for Owner
G I a. �4 .
STATE OF FLORIDA `
COUNTY OF ulcLb
Sworn to (or affirmed) and subscribed before me of
yPhysical Presence or Online Notarization
this day of _Z? 2020 by
i' Ve k'1 Q.S
Name of person making statement./
Personally Known OR Produced Identification
Type of Identification
Produced t - I a C -
(Signature of Notary Pub[- State of Florida )
Commission No.
Signature of Contractor/License Holder
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 )
(Se jFREYB.HUMPHREy mmission No.
MY COMMISSION # GG 30081
EXPIRES: March A )n
(Seal)
--'a'
Bonded Th
s:a.-a7zrz-ak�z �
t, Notary Public Undenrri
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rs
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ZONING
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VEGETATION
SEA TURTLE
MANGROVE
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DATE
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DATE
COMPLETED
Rev. 5/6/20