HomeMy WebLinkAboutBUILDING PERMITAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
®" 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:
PROPOSED IMPROVEMENT LOCATION:
Address: J2-1 I
Property Tax ID #: ��
Z 5 �"
V
Lot No.
Site Plan Name:
Block No.
Project Name:
f
DETAILED DESCRIPTION OF WORK:
,� , ,. r'- , - - - - f
f..
r� -, 5 Y ...y C"I
57: r)
0 1� V V
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION':
Add itti naI work to be performed under this permit- check all that apply:
V Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:`<�-�,
Cost of Construction: $ '5�5co , rV
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name r
Name l
Company: i+ro
Address:
City: �S1�i(Lr� State:_L-
Zip Code:J(5jC) J Fax: C2C]
Phone No -1-- ,-"
Address: 2
City: ( e_ State: f V
Zip Code: Ltcm Fax: 9u5 - 35 (10
Phone No. t-i(D(�=i7
E-Mail: 1,1f_PI 01390 OCO WM
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
1
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.
SUP EII.VIENTAL CONST : CTIO f IN t M�,TIC »
..... .. .... .. .. ... ';:. :..
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
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 clothe 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 proQperty. A Notice of Commencement must be recorded in the public records of St.
Lu County and posted chn the jobsite before the first inspection. If you inte d to obtain financing, consult
it len r or a attorn befo co mencin work or cordi o r Notic of Co men ement.
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Si natu o Own "r/ Lessee/Con ractor as gent for Owner
Si nature of Co tr cto /L cen a of r
STATE OF FLORIDA
STATE OF FLORIDA i
COUNTY OF 011 n
H
COUNTY OF KAn h
Sw9pn to (or affirmed) and subscribed before me of
Swor to (or affirmed) and subscribed before me of
V Physical Presence or Online NotarizationPhysical
this _L2_ day of 2020 by
Presence or Online Notarization
this _L'�-_ day of ii 2020 by
( iI ie kJod F I�4
i"Lad
Name of person making statement. .-
Personally Known OR Produced Identifi
Type of Identification d
Produced
Name of person making st ment. K
Personally Known OR Produced Identificati 'M
Type of Identification d
Produced
(Signature of Notar Publi -State of Florida) "t;;rdd,
Commission No. (Seal)
(Signat re of No ry Public- Statelof F Sida )
Commission No. )f (Seal)
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