HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED q
Date: I"epaq- C9 L Permit Number:
RECEIVED
' 0 llJ5 APR 2 2 1011
Building Permit Application Pprmitting Department
Planning and Development Services St. Lucie County
Building and Code Regulation Division Commercial Residential V
2300 Virginia Avenue,I Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
PROPOSED fIUtP GIUEME T11 1110M
Address: Rrt s✓ ) p�
Property Tax ID#: '►da. ew\-ds%i- •CS 00- 1 Lot No.
Site Plan Name: Block No.
Project Name:
New Electrical Meter Second Electrical Meter
G0 NSTR(1CTI , INFt3RMATI�
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: $ Utilities: —Sewer _Septic Building Height:
O0 1 EAR/IIMR CONTRA W.
Name � Name:
Address:: 601 Lk _ i fC• Q Company:: �_
City: 1"CJ� -I C L State: Fk Address. • ,`? • :, 3'�_, : ._
' z.
Zip Code:�qc1�2' Fax: State:
PhoneNo. �1 /�C ,. J_s ' x ZipCode,.�_ Fax:
E-Mail:,�7fSSQ � `�c� � @,q(Y�k '0-A Phone No a"
Fill in fee 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.
SUP LiE WT II AL CONST �l1�Tt NFL@,JJRWJ11 FCIRMATtON•
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 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 attorr1ey before commencing work or recording our Notice of Commencement.
Sin r' f Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
Sli TE OF FLOI;VDA STATE OF FLORIDA
COUNTY OF L•Oc-,e COUNTY OF
Sworn to(or affirmed) and subscribed before me of Sworn to(or affirmed) and subscribed before me of
Physical Presence or Online Notarization Physical-Presence or Online Notarization
thisZLX� day of ck 202a by this day of 2020 by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Nota ublic-State of Florida) (Signature of Notary Public-State of Florida )
Commission pEANNAGIVENS ommission No. (Seal)
.515 4rx_ Notary Public•State of Florida
<: ommission=NH 08635202
''•'F'ov�°o-` My cor N tional Notar!A n.
REVIEWS FRONT ZON dthr u LANS VEGETATION '-SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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