HomeMy WebLinkAboutBuilding Permit Application 3:
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3- Permit Number: a1d�-�SCoO
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RECEIVED
- -Planning and Development Services Building Permit Application
MAR 19 1011
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Building and Code Regulation Division Commercial Residential PermittNi6 Dzaartment
2300 Virginia Avenue,Fort Pierce FL 34982
St. Lucie Courrty
Phone:(772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR:
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Address: LeAt
Property Tax ID#: a3�3 (011 U IJO5 v 0oh Lot No.
Site Plan Name: Block No.
Project Name:
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New Electrical Meter Second Electrical.Meter
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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:
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,Cost of Construction:$ 5COC3_ Utilities: —Sewer _Septic Building Height:
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Name 7—rc-0 1S 34�� Name: V—C,\s S
Address: �1Ug rC , L.v\ Company:
City: �� Y wyd__ State: F L Address: A 0
Zip Code: 3L19 Ll 5 Fax: City: Stater
Phone No. _Y\a o1 �U11 Zip Code: 3qQ6k< x:
E-Mail: \\T cN.0 Cq V6� 00� CA 6� Phone No
Fill in fee 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.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name: RECEIVED
Address: Address:
City: State: City: t
Zip: Phone Zip: Phone: Permitting naP=1CtgPr--
St. Lucie
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 lender or an attorney before commencing work or recording our Notice of Commencement.'
Si atto of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Sk . 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 -°\ day of d`l\d�t ,202� by this day of ,2020 by
`�t a.'1\'.5 RR.\\
Name of person making statement. Name of person making statement.
Personally Known OR Produced identification Personally Known ' OR Produced Identification
Type of ldentifi ion Type of Identification
Produced L Produced
(Signature of Notary ica •• ' ,of Florid�a�tNA GlvEss (Signature of Notary Public-State of Florida)
?; q Notary Public•State of Florida
Commission No. �'� Cam�{ppuussi k HH 086359
My Comhii.6, res Jan 28,2025 Commission No. (Seal)
Bonded through National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.5/6/20