HomeMy WebLinkAboutBuilding permit application, originalAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Z I Permit Number:
4U; 1CLL
0 7" T"c `' -`"`� Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34-482
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: Cv0,1 C arfp
PROPOSED IMPROVEMENT LOCATION: --
Property Tax ID #:
Site Plan Name:
Project Name: o " to S L--6 6
New Electrical Meter Second Electrical Meter,
RONS.TRUGhON INFORMATION:
Lot No.
Block No.
Additional work to be performed under this permit- check all that apply:
Mechanical — Gas Tank — Gas Piping Shutters r Windows/Doors Pond
_ Electric Plumbing _ Sprinklers _ Generator _ Roof Pitch
fli Sq. Ft. of First Floor:
Total Sq. Ft of Construction: /�"
Z- t' n - - Utilities: ,Sewer _Septic Building Height:
Cost of Construction: $
Na
State:
Zip Code: 3 4ci5; ( Fax: n� - —
phone No. 7 7 'L. ,�3_1
E-Mail: ►� ��
RM in tee Wmpie Title Holder on next page ( If different
from the Owner lured ebm)
CONTRACTOR:
Name:
Company:.ThLAc e L L
Address: ► 7'{ S _
City: Stater
Zip Code: SLY 9<3 Fax: _
Phone No 7 ?—
E-Mail C G i
State or County License r D 2. y &Q e (Q
If value of construction b 2500 or more, a RECORDED Notice of Commencement is required.
R value of HAVC is $7,5W or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicab
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
r•;+.,
Zip: Phone:
Not Applicable
State:
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, consu:t
with lender or an attorney before commencing work or recing your Notice of Commencement.
er/ Lessee/Contractor as Agent for Owner Signature
STATE OFFL
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
hysical Presence or Online Notarization
this day of /Yl ()Crjj 2020 by
STAT
COUI
ctor/License Holder
FdORID�► I ,
Sw• o3p to (or affirmed) and subscribed before me of
wPhysical Presence or Online Notarization
this Wday of �-C-{i, 2020 by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification,,_� Personally Known OR Produced IdentificationSG'
Type of Identification Type of Identification
iP F" !' i'r Qn Produced
(Signature of o bi ` too gnatureestat�of Florida )`.
NOTAJ�Y�PI BLIC AR Colleen Demers
Commission No. STATE'�I� LORIDA Commission No. NOTARI IC
STATE OF FLORIDA
Comm* GGI8N63 i
2022 iq E 'I
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TPJIRLE 2� 2Rl�fNGROVE l
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW I
RECEIVED
DATE