HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �� ��
Date: �19-71/ Permit Number.
Building Permit App1icati®n ,arm;tt03C 0t
Planning and Development Services St.
Luc12 °k
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:
- ROPSED 1 kb
V 7 LOCA tlON
Address: A,ZV
Property Tax ID#: 0'e05 ,?33 Lot No.
I Site Plan Name: Block No.
Project Name: 4&&A/)5/� i
iEA3LED ��ESCR)PTION" OF 111JOR) r
f
•7 t nn d 0
New Electrical Meter_I Second Electrical Meter
'CCINCTRUCTIO#V IJVf ORMATIOf�z { .
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:
Cost of Construction:$ ����� G Utilities: _Sewer _Septic Building Height: j
Y
i Nam ry -q'v Name: -14� a
4drM: z12 Company:
City: zl.,� Stater Address: �i1�6 ° I
Zip Code: ?V9o� Fax: E Z City:_ 4� _State:
Phone No.6W Cm- 3//)® -Voa Zip Code: 3 Y-19 Fax:
E-Mail: Al1140 ®NGe�rsfz�� Phone No 7�2-� `�Z�� f`/D i
Fill in flee simple Title Holder on next page(if different E-Mail
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. I
SUPRLEI�I,iEN=TAL CONSI RUCT{E�N L{�N LTV+J INFORII%iATION {
#.
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 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 o Record a Notice of Commencement may result in paying twice for
improvements to yo r prope . A Notice of Commencement must be recorded in the public records of St.
Lucie and steal o he Jo site before the first inspection. If you intend to obtain financing, consult
nd r a before commencingwork or recordingour Notice of Commencement.
Signature;FRID
er/ Contracto as Agent for Owner Signature of Contractor/License Holder
STATE O STATE OF FLORIDA
COUNTY COUNTY OF
Sw rr to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Pre ce or Online Notarizati n Physical Presence or Online Notarization
this day of 283fJ"6y this day of 2020 by
P N IH o w y th2]?
Name of person malting statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identifica io rr Type of Identification
Produced �Y 0 t, Produced
(Signature of No ublic-State of Florida ) (Signature of Notary Public-State of Florida)
'otY�Ss�• AUDRE-Y B a J F
Commission No. :'�•' ��: {5�'�1ffHREY Commission No. (Seal)
m Y COMMISSION#t GG 339817 "
EXPIRES:March
,ond W Thru Notary public ndenvr'ters '
REVIEWS FRONT � ,G, z5g-RE'RVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
iev. 5/6/20