HomeMy WebLinkAboutBuilding Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
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: n I
Address: 'L 7 q S dle (cs,� t +k iCJ ` /
Property Tax ID #: 2 3 2 D S D I - OD s " ODD q Lot No.— 4/_
Site Plan Name: I t , Block No.
Project Name: �11r��►'1� -��!*�J /Vlo �G(� i/l- f4i•' �c�r/�,o�,
DETAILED DESCRIPTION OF WORK: I
New Electrical Meter ,#— Second Electrical Meter tk) P
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply: —
Mechanical _ Gas Tank ✓ Gas Piping _ Shutters Winndows/Do/ors Pond
v�Electric U`//Plumbing _ Sprinklers _ Generator ✓ Roof I/_ Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ % 6(0 zpd Utilities: —Sewer Septic Building Height:
OWN ER/LESSEE:
CONTRACTOR:
Name
Name:
AA.e t,,(
/
Address: ?? KN 5Q/0C kSn�i I
Company:
Address:
(_Di (CW115(-f"•c1a �Piy io5r L�-C
y17 5 j/ocLSn1-f I, t&,i
City: -/-+ 2,0/ t%L State:_
Zip Code: 3qyu,' Fax:
Phone No.
City:
Zip Code:
Phone No
F4 State: FL
3 K jq S Fax:
`7 79-" Si " OSS 8
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail (i)
Ny ko "cc i (` cv
State or County License 2 7 7
If value of construction is z5uu or more, a KtLVKUtU Notice Or 1-0mmencernenL n ICyuucu.
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: �L �PS.on � (� Insx;-ee
Address:ran� . �,c 6(p� an�u.� ��•''
City: State:
Zip: Phone -7 3l1 YSbo
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:_
Address:
City:
Zip:
Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
e:
_Not Applicable
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 ney efare�mencing work or recording your Notice of Qorrymencement.
_C
wner/ Lessee/Contractor as Agent for Owner
=ATE
Contractor/License Holder
=STAF
LORIDA
FLORIDA
COUNTY OF ,;-
COUNTY OF -:3f Lt ,` , t
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 ly J(tfrn h= 2020 by
this day of 2020 by
0A
tea: e
Name of person making statem
of person making statement.
,jrf •a Notary Public State of Flor
Personally Known ORefifift�ko�r `;liar ^ ,
1n
�Pers Wally Known OR Produced Identification
Type of Identification My -es 01/2i«�•
Yp my ciQa 0v262o2.,
�0"'
T of Identification
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Produced
ced
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(Signature of Notary Public- State %�.4 aG
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(Signature of Notary Public- StateLFIQpkh%,) Notary Public State of
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C13L EZOZ-9Zl�O sa' d3
Commission No.
4'►�ommission
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issicn
_ ( y�°mmis�ion GG 2e�nSt,='
No. �, / CC?al Rpires 01126 2023
,el°N
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/ZU