HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: `� J5 Z/ Permit Number:
LUCE;
g 4;- W- �U 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: �- �` c, ;, �- C1 a
PROPOSED IMPROVEMENT LOCATION:
Address: �C 1 (ilk oc,)(!!:> 3�1S-2—
Property Tax ID#: Lot No.
Site Plan Name: 1"`�� ( � Ct �`} 1 qW(o Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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art �
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 >-41umbing _Sprinklers _Generator ,Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: &COOOSe, CONTRACTOR:
Name t r o Name: f
Address: 79 // ''••S V1, _6 e-t)a Company:T7 rl
City: I�11Gr� State: Address;/ ? (?v
Zip Cade: Fax: City: QI + ( ACI tom'' State:
Phone No. 2; 222.2 Zip Code: �5� Fax:
E-Mail: Phone No ) 01 — j 3 7 —Fill in fee simple Title Holder on next page(if different E-Mail/11cy— en Q aywl J
u.4c r C"Gk�t
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.
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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 BANDING 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 L 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 th jobsite before the first inspection.if you i tend to obtain financing,consult
withilender or an attorne bef a commencing work or recordingNour N iceofCompy0cement.
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Sig ature of Owner/lessee ntractor as Agent for Owner Signatu of Contra or/ucense H i r
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF I Lac-f e-, COUNTY OF ST L CA"e-
S ri�t�,ri to(or affirmed)and subscribed before me of Sworn to for affirmed)and subscribed before me of
P ical Pres nce or Online Notarization P ical Pre nce gr Online Notarization
thls y� ay of /-i 2020 by this ay of ' 202$by
Name of person making statement. Name of person making statement.
Personally Known Z OR Produced Identification Personally Known V"" OR Produced Identification
Type of Identification Type of Identification
Produced Produced
19,
Signature of Notary pu Signature of Notary Public state of WANE COL
IANE COLE
:';� - _: Nota�ry�, State of Florida :i Nota►Y Flibtk-Stara tarida
Commission No. t �ii N GG 961099 Commission No. 's "`nExpi� A 2
02,
of r+ My Comm.Expires Mar 14.2024 MY Canm.Expires r ,Asm
"—"bonded tfirovRh National Asset
bonded ffiroughNatianal Notary Asset.
REVIEWS FRONT : . ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
RATE
COMPLETED
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