HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BF ACCEPTED
Date.
Planning and Development
Services
Building and Code Regulation DfWsion
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2300 Virginia Avenue, Fort Pierce FL 34982
Phone: 772 462-w1N1553 Fax: (772 462ml578
Permit Number.
Building Permit Application
PERMIT APPLICATION FOR0
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Co mercia
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PROPOSED IMPROVEMENT LOCATIO.N.
Address.ft r
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P ro e Tax ID #,Go :3 444 )L2W
P rty
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Sl*te Plan Name: 81ock
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Project Na
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Eq ETAILED DESCRIPT-10N Of WORK
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4el cp�u 0J &
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New Electrical Meter 'Second Electrical Me -ter
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STRUCTION.INFORMATI . . - --- i
ION:4 ;:_,� « A�, _.� _Y,-,..w,.-:.t._�:?Nw, -I... _k I
Additional work to be performed under this permit —check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters ' W. Windows/Doors _Pond
_Electric _Plumbing _Sprinklers � Generator _Roof Pitch
Total Sq. R of Construction a. 3 2MI4000
3, 51? O
Cost of Construcb*on: $
Utilities: Sewer
Sq. Ft. of First Floor:
_ Septic Building Height:
ER/LESSEE: CONTRACTOR:
Name co laz � � � Name:
Address: ►2- �
�q � w /SI .�� Company: .ni wv rf0<M=1 ti �e-
y: .lh o � �o�p � staState:cit L.Address: 0 G
Zip Code: 3 3 0 )�-j Fax: swoop
City: 5 tate.��
Phone No.12s �,� Zip Code,*,. � 4m, q $� Fax:
or
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E-Mail: � w OLG a cxjl�qh Phone No � �� G �8'�
Fill'l'n fee simple rrtle Holder on next page if d rent E-Mail
from the Owner listed above) State or County License Coe
tF value of construction is 2500 or more,, a RECORDED Notice of Commencement is required.
V 1
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGN ER/ENGIN EER. _ Not Applicable MORTGAGE COMPANY: _Not Applicable
I a
Name: Name:
Address: Address,.
City: State: City: State:
Zip: Phone 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 peRnit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Astcxiation rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult uvith your Home Owners Association and review your deed for any restrictions which may apply.
Inconsideration 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 ng 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 rewh 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 Jbbsite before the firstinspecUon. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording vourof Commencement.
y 0 Pei,
Vgnattuure of Owner Lessee/Contractor as Agent for O%ner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORID�1_
COUNTY OF 5A"Tlll1 LAACwwok Z COUNTY OFabN�1lS Irmw�
Ll�1•G�Z
Swo)r to (or affirmed) and subscribed before me of SWMAP (or afrirmed) and subscribed before me of
h ical Presence or Online Notarization P ical Presence or Online Notarizatlon
this day of Ft Fx�+o�� . �630 by this day of 4M by
ap�.l �Od.1
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Name of person making statemerrt. Name of person making statement.
Personally Known OR Produced Iden catimpZS.. Personally Known OR Produced Identification_
Type of Idenn Type of Identifigtion
Producedr, I i s (�n�siL Produced FL �?r � �fGIs L% CA^f0 MEOW
s�
(Signature of Notary Pubflc- S THY J. MERSHONaMENDR nature of Notary Public State ot f-1
mmlssion No� �`�+ ��� aI�Q►ery Public, Slate of Flo da � ,�� '� � THY �• IAERSHMHMDRICKS
�Commission# GG 29849 mission No. � I blic, State a� FWd,
My comet. expres Feb. 1211 � �c1 ��i' S_ GG M95
M) oomm. e,�ires Feb. f 2, 2py9
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE -
COMPLETED
ev. 5/6/20 JI b 4 -w .1
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