HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 102 Permit Number:
L5 Lam(- f LU-7_112
tY 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:
Address: -7
L i n k In/c,.
Property Tax ID #: y4 -000-�
Lot No. 3 7
Site Plan Name: Block No.
Project Name: 1--, 7-
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit— check all that apply:
Mechanical Gas Tank —Gas Piping X Shutters Windows/Doors _ Pond
_ Electric — Plumbing _ Sprinklers
Total Sq. Ft of Construction:
__.. Generator Roof Pitch
Sq. Ft. of First Floor:
Cost of Construction; o
$ Utilities: — Sewer _ Septic Building Height:
Name r &, ZOO -e_Z
Address:j�,Y.'L 8A U Lrn)_< I�ay
City: PS L _.: State: FL
Zip Code: 3q 9�) Fax -
Phone No. 77, - &'f -
E-Mail: Il a
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Company: COA4 -r/
Address: ,2 3 6 ti . L1'r
City:—C��C�'r State:
Zip Code: s3 y 9 ZA Fax: '772- y` 1-4b'-r
Phone No 772- 1-& -al
E-Mail TO
State or County License,fe C 1,9 / / S/J 0 f
11 vawa V1 wIMMULIvn is 4*wor more, a MMUKUtU FYotice of commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
UESIGNER/ENGINEER: �C Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: c Not Applicable
Name:
Address:
City:
Zip. Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone. -
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
1 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 'd
cons) eration 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.
of er/ Lessee/Contractor as Agent for Owner Signature of Contrac r/License Holder
STATE OF FLORIDA STATE OF FLORID
COUNTY OF SY- L.ICt., a COUNTY OF SS _1tC4
-e
Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
Je Physical Presence or Online Notarization _ Physical Presence or Online Notarization
this 1-7 day of 02 rA'e' 2020 by this -_C1 day of 2020 by
Name of person making statement.
Personally Known OR Produced Identification ef
Type of Identification
Prod uce7d
of Notary Public- State
CARRIE ELLEN IV
COmmIS51On No. �� ,`I?a`t3l) Notary Public - State
r 8`
Commission # HH
M Comm. s
REVIEWS FRONT ZONING SUPERVISOR
COUNTERREVIEW REVIEW
DATE
RECEIVED
PLETED
Name of person making statement.
Personally Known OR Produced Identification Y
Type of Identification
Produced f G- IR p 96 /2%S Le a
jture of Notary Public- State of Florida i
30
PLANS I VEGETATION
REVIEW REVIEW
fARME ELLEN iWANKO
Iliry Public - 5tate of Fic
Commission # HH 02613
REVIEW I REVIEW