HomeMy WebLinkAboutBuilding Permit Applicatlion All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
LIM LL I U,UI
Y n 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: 51U_Q _-r 00( KCod LLG- _
Address: 10001 '��t✓1.Lk ?-
PropertyTax ID#: �_ ��( L �L� ` _ .,__ Lot No.
Site Plan Name: Block No.
Project Name: i]11 -�1 i _ __
1� N °. '.�f' 1t•- a- Y. p-Y'P ge
AT g4 ...y 6 y 4 T' P ti N h Y-
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New Electrical Meter Second Electrical Meter
10 ri '� a r. .p - r'c
Additional work to be performed under this permit-check all that apply: f
_M7chanical _Gas Tank _ Gas Piping Shutters _Windows/Doors Pond
—Electric —Plumbing —Sprinklers Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: Sewer _Septic Building Height:
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Name p1 t_U r_I-eJ - (i U—C, Name:MGU1'1 Ct F _. . .-
Address: -e_ Company:
City. State: Address. ti
Zip Code: Fax:Sfil-�0 9Z29 City:)*SL �no 1 0lc _State: �L
Phone No. .SG 1.12-2;z Zip Code: 33411 Fax:Sol 7q0,4(A-2—
E-Mail: damellernoore L-0 YAR i . e r"� Phone No0-
Fill in fee simple Title Holder on next page(if different E-Mail�
from the Owner listed above) State or County License
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.
Firl M. —
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. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/Lice se Holder
STATE OF FLORIDA I STATE OF FLQRJDA
COUNTY OF COUNTY OF
iswor (or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
I Phwa�l�cal Presence or Online Notarization ✓Physical Presence or Online Notarization
this 'viay of_. h by this day of N&CXYM 2020 by
zn� F_ 1E L rat pruk r -- -
Name of person making statement_ Name of person making statement.
Personally Known__ZOR Produced Identification Personally Known V1 OR Produced Identification
"type of Identification Type of Identification
Produced Produced
(Sig tur ,Aa(��ic-S. �I L�I�g rR 3 (Signature of Notary Public
.,�� :,}•• HUNNER NICHOLS
ZCommission#G 10�07Nai+�� 5ta[e of Ftarroa
Commission o. ree May? , Commission No. y CBirsn X GG 23
Ofridp Bwkod71ru8udg91NpbgF6 au r} My Comm,Expires Oct 20.2022
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.