HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: p
jj 17 � rt 9 Fc
�77_Building Permit Application %
hey C�rjt
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: a.t�/��G/_� 154 c�C/ Z
Property Tax ID#: ,A 15b`/7, Lot No. c26t--2�
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
[CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical
_ Electric
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction: ? 7 c>
Cost of Construction: $��� D�
_Gas Piping
_Sprinklers
_ Shutters
_ Generator
_ Windows/Doors _ Pond
Sq. Ft. of First Floor:
Roof Pitch
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name �J�jJ,eTh1�y ��P/�!_,�r9�t.ti
Name:
Address: `790,5-
Company:
City: ?h551' OEfL' State: f/
Address:
Zip Code: S?C S— / Fax:
City: State:
Phone No. .? _ /.�
Zip Code: Fax:
� /7
Phone No
Vinif
Filee simple Title Holder on next page (if different
E-Mail
from the Owner listed above)
State or County License
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 CONSTRUCTIO . IEN LAW INFORMATION, -.-''-
DESIGN ER/ENGI NEER: JZ Not Applicable
MORTGAGE COMPANY: _ of Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: of 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 lender or an attornev before commencing work or recording vour Notice of Commencement.
ignatur / Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA i ,
STATE OF
COUNTY OF c 5 Cie
COUNTY OFORIDA
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online N tarization
Physical Presence or Online Notarization
this day of / , 202. by
this day of .2020 by
ma 1 *
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification �y
1��
Type of Identification
Produced
Produced
-VAUGHN
Florida Notary Public
(Signature otary e y COMM�sslon Expires
(Signature of Notary Public- State of Florida )
oc Ober 22, 2022
Commission No.
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.