HomeMy WebLinkAboutBUILDING PERMIT APPAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 '21-a-? I Permit Number:
�UJ
_°" '�� '� - 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: 7G0 Cyp--e S S4. R,-- 5-1. LLc t F-G
PropertyTax lD#: 3til �- SO/- 0c)(00- 000--$ Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
0 i . . /I
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 _ Shutters _ Windows/Doors _ Pond
_ Electric — Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 1 00, a d
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name I-i C
Name:
Company: isf �go ; W e:"t ,o
Address: /fSI
-3on/J
Address: 103� S Sf��'� �r +'¢uP
City: 00� Ltuc; P State: FL
City: %rt
Stater
Zip Code: 3 Y Fax:
Phone No. (PO/- %
Zip Code: Fax:
Phone No 177"D) .37 D - oat 9(f)
E-Mail 0 2oo1'G o/�� yo-
"-
0t) . CoE=
E-Mail: ✓►. j CkeV ,P (V 4r-,a " C b e-1
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
11
State or County License 8SY
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:
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 aply.
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 ature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF 'Sei-' ,uct'Q,
STATE OF FLORIDA `
COUNTY OF �+ L(JC4 4e,
Sworn to (or affirmed) and subscribed before me of
+" Physical Presence or Online Notarization
this day of 2020 by
Sworn to (or affirmed) and subscribed before me of
—_4Z*Physical Presence or Online Notarization
this day of 2020 by
Name of person making statement.
Name of person making statement.
Personally Known'" OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Pr uc
Type of Identification
Prody�€d
(Signature of Notary Public- State of Florida David Raymond
o�P Y,�,
o�' . o� NOTARY PUB
Commission No. 1�% =STATE OF FL
a Comm# GG28
's
Pi(5ignature of Notary Public- State of Flor' David Raymond P
IC g. c � NOTARY PUBLIC
FabAimission No. U i�Ja� ' STATE OF FLORID
52 + Comm# GG2870
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