HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /,�% Permit Number: 2/1)3 r o �� 7
Building. Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce F134982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial Residential
V/
PERMIT APPLICATION FOR: -
PROPOSED IMPROVEMENT_ LOCATION:
Address: i 9SZ✓
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK: tea►% v�� ..�1�� lrt� , t,t,��?
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION: I
Additi nal work to be performed under this permit — check all that apply:
7(Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric _ Plumbing —. Sprinklers ^ Generator — Roof Pitch
Total-Sq. Ft of Construction: Sq. Ft. of First'Floor: —
ev
Cost of Construction: $ Utilities: _ Sewer _ Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name GDV
Name: f-)uAL42 e, &Yk,6a %
Address: ��z6(f C41�94AriX Z-1-0
Company:4' Gt'is g'Jitir gtL't� zL.cJG
City: State
Address� --41, /� s Z:� � 9
Zip Code: _1�9 r2, Fax:
�S��g&s
City: Ric--�— f°'u's State:--F—Cr
Phone No. U U2 6 :7 / 7 2 Z '�
Zip Code: Fax:
E-Mail: r��
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail 4 4(,14 CC-14 r Lam`
from the Owner listed above)
State or County License 2S f i 3
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
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
Address:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
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, wails, 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.
Signatarriot Owner/ Lessee/Contractor as Age t for Owner
Signature o Contractor/License Holder
STATE OF FLORIDi�
STATE OF FLORIDA
COUNTY OF �
�-VG�2
COUNTY OF 5 ur-r—
Sworn or affirmed) and subscribed
before me of
Swor (or affirmed) and subscribed before me of
Physical Presence or
Online Notarization
Physical Presence or Online Notarization
this.3& day of 177 4,
20�[ by
this day of 20Lby
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identific L�
Personally Known OR Produced Identification
Type of Identificati
.\\..
$ 40a:
Type of Identification
Produced
o
Produced
(Signatur of Notary Public- Stat6
of Florida } c m
o
(Signature of Notary Public- State Florida)
v
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Commission No.
(Seal) 6 N .r=
Commission No. (Seal)
D c 3D
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REVIEWS
FRONT
ZONING
10AFAVii
PLANS
VEGETATION
SEA TURTLEMA
NO .
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
fig
DATE
m J��
ND. co
RECEIVED
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DATE
COMPLETED
Rev.5/6/20