HomeMy WebLinkAboutpermitAll 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 ll✓/
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION: 4
Address: % _10(7) N L4 1 nl N Al A-. %I✓1A1T1
Property Tax ID #:
Site Plan Name:
Project Name: y�
I
Lot No.
Block No.
NO
o it r.-i'r 1 C/ v—1 A)) _ In 1r'A �� �f`�� � .6''C,P _ % v� .�- ►� I t hn. � �����
New Electrical Meter Second Electrical Meter
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CONSTRUCTION INFORMATION: I
Addy iti%nal 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: Sq. Ft. of First Floor: _
Cost of Construction: $ '55—t Utilities: —Sewer _ Septic
Building Height:
OWNER/LESSEE:
CONTRA TOR:
Name
Name:
Address:
City: ex State: F_�,
Company: C
Address: CU &
Zip Code: Fax:
Phone No. -67'3 ji-" ' 5_3 1 �r
City: _viA�lCi &_C1(0A State:
Zip Code:_?22� (10 2 Fax:
E-Mail:
Phone No —77 -,)— -71 -2, — ?7 / (o
E-Mail ;2 — W
Fill in fee simple Title Holder on next page { if different
State or County License
from the Owner listed above)
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.
SUPPLEMENTALCONSTRUCTION LIEN LAW INFORMATION.
DESIGNER/ENGINEER: _ Not Applicable
pp
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.
1 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 our Notice of ConVnencement.
Signat a Owner/ Lesse ontractor as Agent for Owner
Signatur f ontractor/Li ense older
STA E OF FLORIDA
i
STA OF FLORIDA `
/
COUNTY OF d/�%i�1i/ 1�.�y'
COUNTY OF G �, '! / Gov
Swo' Frto (or affirmed and subscribed before me of
Swor�to (or affirmed) and subscribed before me of
V
yPhysical Prese a or Online Notarization
this � day of 2020 by
Physical Presence or Online Notarization
this._ %tJ day of 2020 by
Name of person making statement.
Name of person making statement.
Personally Knowny OR Produced Identification
Personally Known V/OR Produced Identification
Type of Identification
Type of Identification
Proclimed
J�
Prod e
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(Signa e
GWENDOLYN I. BEL
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(Signatu ; _ . � P 1
W COMMISSION # 1�A551
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PLANS
VEGETATION
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MANGROVE
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REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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