HomeMy WebLinkAboutBuilding permitg appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
quo,
° ff,u 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:
PROPOSED IMPROVEMENT LOCATION:
Address: D c,
Property Tax ID #: 130 1—bQS - 0.%Q - - 1 Lot No.
Site Plan Name: Gfu Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
dew, D C 00 cbt)N �ex
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: 1 -1 %Sq. Ft. of First Floor:
Cost of Construction: $ 10, %QS Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Address: 0OdandCompany:
City:
Stater
Address:
Zip Code: BRs I Fax:
City:
Stater
Phone No. 1410 _3 1-
Zip Code: 3a?j Fax:
A
E-Mail: 1
.
Phone No-Rg_a__5Xff
E-Mail
Fill in fe imple Title.Holder on ne page ( if different
from the Owner listed above)
State or County License" 0,21C
6 (4 S_
It 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:
DESIGN ENGINEE : Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
State:
City: Sta e: City:
Zip: P one - - Zip: _r 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.
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
may apply obit such
structure. conflict
consult withpyolur Home Owners Association your deed for any restrictions which
lease and review
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 A Notice of Commencement must be recorded in the public records of St.
your property.
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 our Notice of Commencement.
5". N
ad —
-
Signature of er/ Les as Agent for Owner
Signature of ontracto icense r
STATE OF FLORIDA
COUNTY OF
STATE OF FLORIDA���
COUNTY OF ((J�
Swor�o (or affirmed) and su scribed before me of
Sworor, affirmed) and subscribed before me of
qrph
/� Physical Prese or Online Notarization
this day of 2020 by
sical Pres a or Online Notarization
thisday of 202(D by
Q d
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Name of person makings tem nt.
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Name of person mak��O!R
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Produced f8 �t&
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Personally Known OR Produced Identifk?aa o 3
Personally Known
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Type of Identification Q E
Type of Identification Q �
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Produced ~o F o a
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{Signs tary Pu ic- S t o a)
Commission No. (Sea�� f �''
Commission No. (Sealy v �a
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 5/6/20