HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COI�J �_u � 1'ED FOR APPLICATION TO BE ACCEPTED ---
Date: �� �3 \ �� Permit Number:
440f
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: rc \
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #: r� 3 Q`J ''� - ��1 - - Lot No.
Site Plan Name: Block No.
Project Name:
I, DETAILED DESCRIPTION OF WORK:
I ,11AA1n,1Aft,' J, Cin,n ..ti'2/7AI4 i/-t,,_Ir n- ,,.,-- f'�;A I.n1
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
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
l
Cost of Construction: $
_ Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Utilities: —Sewer _Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name re,
Name: MAJunr f • (�12f� (Z
Address: �SC� �� 5. 1� ,,�„rl zinc IJ AL - C!
Company:
City: State: PL
Address: 4b 1 Ol,lb '61yur,
Zip Code: 3314y Fax:
City: S( ( _ State:
Phone No.
Zip Code: 39-8(o d Fax:
E-Mail:
Phone No 7n a - 54�) -(� &3
Fill in fee simple Title Holder on next page ( if different
E-Mail hCl S v' ►G AC, 0 Obi. - Cb M
from the Owner listed above)
State or County License�SI " m l b% 19,300
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.
I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: l 1IILAi ( A.. -I rcu
Address: 1 ;M 4;" 5 .1111114
City: V�� I2(,rZ44:, State: _FL
Zip: 33q3,-a'— Phone
FEE SIMPLE TITLE HOLDER: _/Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: a/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 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/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF Jy\A'Q WRnc
Sw7n to (or affirmed) and subscribed before me of
V Physical Prese ce or Online Notarization
this ��day of 2020 by
m4alo kl SRAA -; 12
Name of person making statement.
Personally Known - OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida) _
Commission No.
Signa ure of Contractor/License Holder
STATE OF FLORIDA,
COUNTY OF J r,&o,yyyrt(
Sworn to (or affirmed) and subscribed before me of
✓Physical Presence or Online Notarization
this &6�day of ,14tj qg-_ - 2020 by
NAJeAf))d It Q_t/ST;F_ l2
Name of person making statement.
Personally Known ✓ OR Produced Identification
Type of Identification
Produced
�)-DIANA L. BRYANT
Notary Public - State of FI "'0)1
Commission # GG 9400 1
1, Fyoires Feb 22 2024
of Notary Public! State of Florida )
'1 No. )BRYANT
Public
State of Flo�da
\ Nota Y mission GG g40062024
•'•..QF ..,
Sonde
: throc3h National NOV
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tional Notary Assn.
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REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev. 5/ b/ LU