HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETE APP TION TO BE ACCEPTED
Date: Permit Number:
Ty.ILUC919
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° * P.0 .��. ,=r. 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
PERM-IT APPLICATION FOR:
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Address: 7 �e 0 7 t(,/q 1✓If 5 /�o�.� A(�� a100 �'�` 'U�t f � -.. /��� >� 3SF�S"�;
Property Tax ID#: f' ®� r 4 d�" U 7 7 d Lot No. 02�
Site Plan Name: Block No.
Project Name:
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New Electrical Meter Second Electrical Meter
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Additional work to be performed , under this permit—check all that apply: /
_Mechanical _Gas Tank —Gas Piping _Shutters V Windows/Doors _Pond
in
_Electric Plumbing _Sprinklers _Generator J Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
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Cost of Construction:$ 190 d dd1 Utilities: ,Sewer _Septic : Building Height:
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DOWNER/LESSE,E i�cx� m�K� r ;r , �s � IO NITRAC�T®R rS r �,.. 107 k
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Name A /415 P 1 , Name: e 7YR i lei .I MC
Address: i� t/A//�rS �✓J Company: /
City: !/Iutf State: Addr S 1,kJ ' /i& &I�/"f
Zip Code:���7�3 QFax: City: d� 5t' Isle- Statef
Phone No..7 7a ' .9 7 7 ` 10 MY
Zip Code: W-T e 9 Fax:
E-Mail: Phone No 7- _ 3 z-3_ ?17"
Fill in fee simple Title Holder on next page(if different E-Mail otd 6l#,4 14 of 0 7 6P S► 1".41 ,ctyr
from the Owner listed above) State or County License (i G 01(0 G �d
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.
SU;PPL M'NV: 'L`CO ' TR T 9N LIEN°LAJN"lN: OR M21. F.M.
NN: u: it _
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _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 and posted on the Jobsite before the first inspection..If you intend to obtain financing, consult
with lender or an attorne before com"rh6ricinj work or recording our Notice-of Commencement.
Signature of 0 er/Lessee/Contractor as Agent for Owner Signature of Co ractor/License Holder
STATE OF FLSTATE OF FL
COUNTY OFORIDA `� 4 I COUNTY OFORIDA�_S
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Ph al Presence r _Online Notarization Ph �5p Presence Online Notarization
this ay of 2020 by this_Oday of 2020 by
Name of per on making statement. = Natne of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification
of Identification Yp
Type /
Produced Produced
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(Signature of ary Pub S P Lq, 011 ignature of Not -S to of Florida)
s LEN VAUGHN ,"nv'd�.
_ fate of lorida-Notary publ c mmission No. ,a°`P °m'- ELLEN
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Commission No. =� o' C on GG 270079 =* ,= o, Florida Notar
�iiiio.� My Commission Expires , P�r� Commission #GG, y PUbl1Q
October
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b"mREVIEWS FRONT ZONING SUPERVISOR PLANS VEGETA G GLOVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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