HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Z_ - Z�� - Z D Z- Permit Number: a,
c1 r. LUCE � RECEIVED
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Building "Permit_ plrlCatiOn Permitting Department
Planning and Development Services , .
St. Lucie County
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: (psp p�t�
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IPA,"
PC3ED�IMPROUEMENT LOCATION'r�r
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Address: 5 A) ZJA
PropertyTax.ID#:. 1 �%! " 3 - Lot No.
Site Plan Name: Block No.
New Electrical Meter Second Electrical Meter
Additional work to be performed- under this permit -check all that apply:
_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:
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Cost of Construction: $ T(�Ci� Utilities: _ Sewer _ Septic
Building Height:
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CONTRACTOR
Name
Name: S
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Address-,," � 3 Us
Compan" .
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City:'' �l'.: �.�+;� State:��
Address:,;,%,,
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Zip,Cgd77e• a-. Fax:
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State
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Phone ,01.6
Zip Code: 3 Fax:,
E-Mail:
Phone No. Z
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E-Mail 6ay.,J
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Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License C G C
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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
BONDING COMPANY:
Not Applicable:'
Name: '-
:Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR F D IT: 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 inspe9tIon. If you intend -to obtain financing; consult
.with lender or anattornev hefnre rorifinenrino wnrk nr rPrnf/rlino vni it Nntii- irnf rnmmonramant
Signatur of Owner/ Lessee/Contractor as Agent for Owner
gn ure of Contractor License Holder
STATE OF FLORIDA
STATE OF FLOINDA
COUNTY OF- Lyl✓1g,
COUNTY OF t4- WC:kG
Sworn to (or affirmed) and subscribed before me of
Sworn o (or affirmed) and subscribed before me of
P sical Presence or Online Notarization
i.. P sical Prese ce or Online Notarization,this
day of v �� 2020 by
this azday of 2020 by
Name of person making statement.
makingment.
Name of person makin7ORProdu
Personally Known OR Produced Identification
Personally Known ced Identification
Type of Identification,- : , •
Type of Identification
Produced
Produced
(Sig _re of Notary Public- StA$ lorNI Sanchez '"a
(Sig re of Notary Public- State Florida )
NOTARY PUBLIC
- Commission No. G/" OF FLORIDA
c
2 �J JaNra Sanchez•Medina
.
Commission No. 363"' /" Si,2i ARY PUBLIC,,
's� 1ba Comm# GG363708
s STATE OF FLORIDA
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