HomeMy WebLinkAboutBuilding Permit Application /drawingAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 - 1/0 - Z / Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial k. Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: i- f yr fV f 7 YYj`f'
Property Tax I D #: / 41� - / / J 0,0 Q 1 _ O O� - Lot No.
Site Plan Name:
Project Name: /- dR
Block No.
DETAILED DESCRIPTION OF WORK: i
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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:
Cost of Construction: $ _77 7,; 610
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name_ -5Gy?
Address:_ T rfr GU J/X -/ 417l
Company: C- S
City: , / u // ��� State:
Zip Code: T L 0 yy Fax:
Phone No.
Address:_
City: State/c_/
Zip Code:3�//��'/ Fax:
Phone No. _ 7 7 z - 7-77%
E-Mail: J C 4IJ o-10 TL C rr,l . Oil
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail '&k/' (-r- c -ids "'7 G (;'i� 6Ar ' X C_d,:4
State or County License 3
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
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: /' State:
Zip: Phone �'
Address:
City: State:
Zip: Phone: .
FEE SIMPLE TITLE HOL _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
City:_
Zip: Phone:
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 jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an dlttnrnpv hpfnrp rnmmnnrino IA —A, nr rcrnrA— it —it fUMi— of r ^n nnrcmnn+
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA I
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COUNTY OF l_ 11 ! 4 ; i L
COUNTY OF ` h
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Swgrn to (or affirmed) and subscribed before me of
S7n to (or affirmed) and subscribed before me of
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ti Physical Presen a or Online Notarization
Physical Prese or Online Notarization
this IC day of 2020 by
this _LL day of 2020 by
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Name of person making statement.
Name of person making statement.
Personally Known ✓ O
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Personally Known OR Pro an
n�'. DANIEL LE B, JEWELL
pe of Identification ��,; �;,
Notar Public - of Florida
Pr duced a' Y
Ty e of Identification
P.rod ed LIE a
I ' P ` DA JEWELL
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Commi # GG 37394
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tlic - State of FI
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(bO x Tres Dec 5
(Signature of Notary Public State of Florida)
Commission No.3 (Seal)
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(Signature of Not ry Pu IIc- St to of -FT- i a
Commission No' u � (Seal)
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