HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -i 1 Perm it Number:
9Vo dUCIL, -�
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110-6 - 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:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID p: 1301 03- 63 %% O 00 - 7 Lot No. .V, 5
Site Plan Name: Block No•5S
Project Name: cagC _Dp��
I DETAILED DESCRIPTION OF WORK:
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
Electric _Plumbing _Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 4X0
_ Shutters _ Windows/Doors _ Pond
_ Generator _ Roof Pitch
Sq. Ft. of First Floor: �
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name t
Address: 8 0S L
Name,
Company:
City: Stater
Zip Code: 95 / Fax:
PhoneNo.92A- d44.5.3. 3-P
Address:
01
City; cDrt e t ,
Zip Code:3,VFVS Fax:%7.2-'iG/'.?77,?
Phone No 77�?- '7Flo*2 09
Stater
370 -L 89
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License _ . IJO 66-E
oos 9
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
INEER: 'Not Applicable I MORTGAGE COMPANY: � Not Applicable
Address: Address:
City: State: City: _
Zip: Phone Zip: _
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Zip:
Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the Issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. A Notice of Commencement must be recorded ' the public records of St.
Lucie County and po$Ied,on the jobsite before the first inspection. If you intenObtain financing, consult
as Agent
STATE OF FLORIDA C� STATE OF FLORIDA �( /
COUNTY OF cJh �ilC'/L COUNTY OF Sfr C LLL/�
Sworn to (or affirmed) and subscribed before me of
Ph y 'cal Presegce pr Online Notarization
this�Tby of M NI f 2020 by
A lCp#&� AtiDL
Name of person making statement.
Personally Known L�/ OR Produced Identification
Type of Identification
Produced
r L�e_
(Signature of Notary Public- State of Florida )
'Qp DaAnn A. Prue
Commission No. G G Qa W %NOTARYPUB
STATE OF FU
REVIEWS I COUN ER I REVI W SREVI W
FRONT ONING
Sworn to (or affirmed) and subscribed before me of
_RhyAical Presgp�e �� Online Notarization
this 1_ ay of /' / V
Name of person making statement.
Personally Known �OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commission No. r Seifij�Ann A. Prue
21MA NOTARY PUBLIC
`FfJ4NS I VEGETATION I SEA
REVIEW REVIEW RE