HomeMy WebLinkAboutBuilding Permit Application t
ARAPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
COUNTY
Building Permit Application
tanning and Development Services
Building and Code Regulation Division Commercial Residential y
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
P.RO, ,OSER IMPROVEMENT LOCATION:
Address: 5N6 S 04?A KyV\ P
Property Tax ID#: Lot No.
Site Plan Name:V :u s(. 6 Block No.
P ioject Name: &du S lz to
DETAILED-DESCRIPTION;OF WORK::
y�f�.��� U,f� gam, p i 14t s A&'Oe
Nlew Electrical Meter Second Electrical Meter
;CQ;NSTRUCTION IN'I=ORMATION
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: $ 2.2. S O • (00 Utilities: —Sewer —Septic Building Height:
01NNER/+LESSEE. - 'CONTRACTOR:` -
Name 0 4.�A G�1r.. ( cy v x Name: ,11s!t_
Address: 540 S QQAW Al LA � f Company: —i-rL (o.,[m_t�t_ IOly S
City: Fe{ P' if State:_r—t Address:8ZF0 Get..--t=:p Lc�
Zip Code:2Y 151 Fax: City: P w V I va:c_ Stater
Phone No. L t .3 —201 — be 71 Zip Code: -)`f T F7 Fax:
E-Mail: Phone No &
Fill in fee simple Title Holder on next page(if different E-Mail 73YC,. Co,.c�fti., tDw S g ^oI. G.
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
Ilf value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW IN;FORMATIO'N -
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
i
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.
it will authorize the permit holder to build the subject structure
St.Lucie County makes no representation that is granting a perm p 1
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,
ac cessory 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 inspectio f you intend to obtain financing, consult
with len er an attorneybefore commencingwork or recordi Notice of Commencement.
Siga Owner/Lessee/Contractor as Agent for Owner Sign re ontractor/License Holder
STZEOF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presence or Online Notarization Physical Presence or Online Notarization
this 'L day of Y)fQpmkht 2020 by this day of_j/y b 2020 by
D\-5j, LW 9 Q,,a�M A 01 J, J
i Name of p4rson making statement. Name of pers n making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produ N. Z_ Produ d C:L
Sign urk of Notary Public- ate of Florida (Sigilahure of Notary Publ -State of Flori
"••'�camsafr�+.�:,,;s9C•is2x•>..,xOria^?:ffc,.u.•-.--,�-,� ox ta•¢zts s�.2=^�^.. :,:'unst<6�£.:ss..^avcc�:%'.ef
Commission No. rY LASH.R(,�I ( 1 jy•FZy,'-{�j- Commission No. vat,:'. 1 7II�11h1G
GRA n f; HNAINGi
_�• :.= PAY COMMISSION#GG 27::UG-i ; _ : :*; MY CO?viMISSION#GG 275060
F•°F F:• Bonded Thru Nola I'ut�lic lfrd r:,i': S,pFF`2.` B nded Thru hotaw Public Ui oerwri
REVIEWS FRO °�01� -- R /196R: PLANS V E G PATONE5E- T -,MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.