HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED %��%
Date: iYCh Permit Number: D 1 ^D�/ `0�'
RECEIVED
91Y.
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WMC��L R MAR 0 3 2021
0
Building Permit Application Permitting DapaWnent
St. Lucie nt/
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:
PROPOSED (IMPROVEMENT LOCATION:
Address: (�J� L � A&�,Aa, 1%i7
PropertyTax ID #: 0 Od O Lot No.16,
Site Plan Name: A) )'a Block No. D
Project Name: IM
DETAILED DESCRIPTION OF WORK:
a�0'01)e q11 jrr'M /Rally 1/9_ 1'4(
I i �� 7
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
a 4 tl WIh O) DWS OUi'
Ci t V
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: nn Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR: A
Name .6 re ne-h- /: n -13 n e4017
Name:
Address: Ylm %llt1 d-i"CL--
Company:
City: Aim - % e.,^c - State: 41Address:
Zip.Code: Fax:
City: State:
Phone No( 40%0 r,�3
Zip Code: Fax:
Phone No
E-Mail: ,br,,12 r/z
Fill in fee simple Title Holder on next page (if different
E-Mail
State or County License
from the Owner listed above)
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 CONSTRUCTIOWLIEN LAW INFORMATION: Al I TJ / 1
DESIGNER/ENGINEER:
of Applica
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone.
MORTGAGE COMPANY: 1/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.
[.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 jo ite before the first inspection. If you intend to obtain financing, consult
with lenclar or an attorney befoommencing work or recording your Notice of Commencement.
Si ature-of Owner/ Lessee/C tr etor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF _/ 'i (�(
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
—/—'Phyfical Presence or Online Notarization
Physical Presence or Online Notarization
this n of �C1 V 20
this day of 2020 by
game Of person making statement)
Name of person making statement.
Personally Known OR Produced Identification _��
Personally Known OR Produced Identification
Type of Identification I
Type of Identification
Produced Gt5C,
Produced
(Signature ota 1 to e o on
rival
(Signature of Notary Public- State of Florida )
K:,tl M COMMMSlon GG 206560
Commission No tires 04Q19&912
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.5/6/20