HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE C' '11PLETED FOR APPLICATION TO BE ACCEP i ru
Date: 3 I2, �� Permit Number:,
RECEIVED
91ro WOE _ MAR 2 2 1011
Permitting Department Permit Application st. Lucia courrty
Planning and Development Services V 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:
N�,�
P.'R_OPOSED IIVIPROVEM:ENT LOCATION: .
_ . ,
Address: /o o -° S -�-oil`i �l 2
Property Tax ID#:- 3 0,1 0�✓ 0"(0 000 -� Lot No.
Site Plan Name: Block No.
Project Name: 8A-C-tt- S` �� w�vtla� /1-1 (/i4c c� T
DETAILED DESCRIPTION>OF WORK::
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0 104, v,4 c e- . .44C,
/h
. Wd J P�1,�,g-e y .�� 6 A—A -
New Electrical Meter Second Electrical Meter /00
CQVNSTRUCT[0" INFORIVI:ATION
ed ,
�4 C Cf}Z w 00eteA &1 YAc
Additional work to be performed under this permit-check all that apply. �1 (, g f PNce.-
_Mechanical _Gas Tank —Gas Piping _Shutters T Windows/Doors _Pond
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: /00 Sq. Ft. of First Floor:
Cost of Construction: $ fT/ Utilities: —Sewer _Septic Building Height:
OWNERAESSEE: . t CONTRACTOR:. '
.`
Name oog- /ove✓,!!�,:a Name:
Address/o o Company:
City: - , " ) eze, State Address:
Zip Code: 3y r2-- Fax: City: State:
Phone No. ?-7 lol- 0Sef Zip Code: Fax:
E-Mail: 119VeA,1 1A. JL.. Aihone No
Fill in fee simple Title Ptilder on next pag'et4 different E-Mail
from the Owner listed above) State or County License
LlIf 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.
SUP�P,LEMEN*TAL CONSTRUCTION LIEN LAW INFORMATIOM.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
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. Ifyou.intend to obtain financing, consult
with le,der an atto"ev before commencing work or recording our Notice of Commencement.
Sig a re of wner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF COUNTY OF COUNTY
`� 1 COUNTSTATE O FLORIDA
Y OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Ph s'cal Presence or Online Notarization Physical Presence or Online Notarization
this '1, ay of 2020 by this day of 12020 by
j���
Name of person ma Ong statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificatio I Type of Identification
Produced L Produced
(Signature of Notary Public- fate of Florida) (Signature of Notary Public-State of Florida )
Commission No. ELLENS)6jjl1GHN Commission No.
:State of Florda-Notary Public (Seal)
Commission # GG 270079
6 ioober 2E, 2022 _
REVIEWS 'OR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 5/6/20