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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE CO LETED FOR APPLICATION TO BE ACCEPT ~� //R� _ Date: �,• �� • a U Permit Number: r3® � r C � 8 v 91ToIL CE - I RECEIVED lam! _. DEC 2 2 1010 - Building Permit Application krmltting Department Planning and Development Services 5t, Lucie unty 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'LOCATfON Address: (-,p-0 O f\ 41 �y�d�%�•-. ��'.j z J L Property Tax ID#: 3-t 0 1 — q 3 1 --4) O 0 1 o © O — 1 Lot No. Site Plan Name: Block No. Project Name: DETAI'LED DESCRLPTION OF WORK.'; 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 _Windows/Doors _Pond _Electric _Plumbing _Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction:$ 1 -7, Q 0 0 Utilities: —Sewer —Septic Building Height: OWNER/LESSEE ~ t CONTRACTOR: w Name uk- ej �-� L4,ne-Y-Ce- Z Name: Address: l I-7 Z Company: Da u,",- t�lne�•- a r/1 City: j�- State: __L Address: 17 Zcn tIJ Zip Code: 3`t°I S QFax: City: C„C f- 1, of Stater!_ Phone No. Zip Code: 3-4,cl Fax: E-Mail: Phone No (-7 7 -1 S Lf 2L Fill in fee simple Title Holder!on next page(if different E-Mail iQ=a V­".(•C n from the Owner listed above) State or County License C-L L 1 7 (;;! L-f 2 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. DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable 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 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 lendKor an attorney before commencing work or recordin r Notice of Commencement. Signature of owner/Lessee/Contractor as Agent for Owner Signature of contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF -6 COUNTY OF Swor o(or affirmed)and subscribed before me of Swor o(or affirmed)and subscribed before me of Physical Presence or Online Notarization Physical Presegce or Online Notarization this j1Z ay of de ,2020 by this LP`day of IJL� .2020 by Name of person making statement. Name of person ma mg statement. Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced p (Signature of Nota ublic-State of Florida) (Signature of Notary Public-State of Florida) Commission No. Ge'2gi77 2& (Seal) Commission No.l,� �00 7 7 ZC' (Seal) Notary PL Ai—cStste of Florida pi �C�Ileen Coll n Sue Hayes REVIEWS R N y com ; 9729 PERVISOR PLANS *c @El" *EF9iEVIEW NGROVE NTER@s0 REWW. EVIEW REVIEW E"P' ° W DATE RECEIVED DATE COMPLETED Rev.