HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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i,? Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential��C
2300 Virginio Avenue, Fort Pierce FL 34982 --
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED.IIUIPROVEMENT LOCATION'.: -
Address: d 7 7 'c/ 3
Property Tax ID #: 21OC2 Lot No. 5
Site Plan Name: Block No.
Project Name: p /') dt .7
DETAILED DESCRIPTION OF WORK
1 Z 09 CC- pr^
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 T Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
00
Cost of Construction: $ . Y�6 Utilities: _ Sewer — Septic Building Height:
OV9IMER/I�ESEE�
CONTRA -TOR
Name 1 Q,' (S c I� IF_-i i i _
Address: �-e_S
Marne: r .e
Company; CDqiA_1_ t `J j�G/j or.1/aA, F
Address:
City: Stater
Zip Code: ::5 q Fax:
Phone No. 7
City:. fl _ /tr State:
Zip Code: 34V9y6 Fax: 77?-YX
Phone No 77?-
E-Mail Tarn, f,yke Q A00, car.!1
E-Mail:
Fill in fee simple Title Holder on next page { if different
from the Owner listed above)
State or County License,ft c Asa 0% -CIS-0 4P_
IT value or construction is Z5UU 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.
.rL.a,ailEn/ CIVUHM tK:
Name:
�c Not A ficable
pp
MORTGAGE CO Y:
COMPANY:
;
� Not Applicable
Address:
Name.
City:
Address:
Zip. Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
_/K Not Applicable
Address:
Name:
City:
Address:
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, 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 youNotice of CommPnrampnt
Signat a of Owner Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF L ucc �
Sworn to (or affirmed) and subscribed before me of
L----'_�_hysical Presence or Online Notarization
this —.2— day of 2020 by
atu
Holder
STATE OF FLORIDA
COUNTY OF cD�-r Lvc lF
Swor o or affirmed) and subscribed before me of
P ysical Presence or Online Notarization
this day of A-f V I iL. 2020 by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known
Type of Identification Type of Identificai
Prod tc �ty?P ^dQl� � UC04.&C Prnri.—A i Er 01 f
of No nRtANDO 'gnature of
OR Produced Identification
�.UEe_ L.IC.,Ea•1,�c
Commission No.
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