HomeMy WebLinkAboutBuilding permit appr
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
17 6 CO) 13 U D to
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: she
Commercial Residential
PROPOSED IMPROVEMENT LOCATION: � _ --
Address:
Property Tax ID #: 3 `f 03
Site Plan Name: it II CI oo --
Project Name:
DETAILED DESCRIPTION OF WORK:
n a o 5 r .100 -CM
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Lot No. —
Block No.
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: a0a Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: ✓fSewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: 0 ti Ire LA
Address: rCompany:
City: State:
Zip Code: �:
Phone No. t ')O - q a 7 ,
!.! She
Address: �•
City: ;U State:
Zip Code: -3a e 1 _7 Fax:
Phone No Q 07-4 aga — 24
E-Mail: ey) d e.o
Fill in fee simple Title Holder on next page ( if differe
from the Owner listed above)
E-Mail fn C (_(mil e4aVX 60 AfATSW•CVVV\
State or County License Y.ohs
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:_
Address:
City:_
Zip:
Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:_
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
_Not Applicable
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 recordi g your Notice of Commencement.
7111-7
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Sign at r f ner/ Le ee/Contractor as Agent for Owner
Signature of Contra cto e Holder
STATE OF FLORIDA
STATE OF FLORII#
COUNTY F
COUNTY OF U
Swo to (or affirmed) and subscribe before me of
(or affirmed) and subscribed before me of
Swo/r.
Physical Presence or Online Notarization
this zu day of2020 by
ysical Preserice r Online Notarization
this 0 day of 2020 by
Name of person making state t.
Name of person making state ent.
PersonallyKnown `� O�duced Identification
Personally Known OR Produced
Y Identification
Type of Identification
Type of Identification
Produced
Produced
(%"rI4 ture of Notar Public- State of Florida)
(Signature of Notary ub Ic State of Florida )
Commission No. Se d
)
tary Public State of Flon
�Y / Public State of Flondi
fission No. ,p `F 1
e y Anne Wilhelm
Ashley Anne Wilhelm
My Commission GG 359334
my Com '
Expires 07/25/2023
w M1 Expires
07/25/2023
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