HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `- Permit Number: 2 (7�-(���Q3
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---x = 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:
PR�QPOSED IMPR®UEMENT LOCATION:
Address:
Property Tax ID#: .L �J�" SVII� bo57 -coo Ig Lot No.
Site Plan Name: Block No.
Project Name:
D ILLED DE�SG I(PTIO11 N 101F WORK:
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New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
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:
OWNER/LE-�SSEE: C®NTRAS91LWR:
Name 4. Name:
Address: y— Company: GL l/1��/1 G✓��G
City: "� LQJL State._ Addre : d3 �� /Yt-� 46 y'
Zip Code: Fax: City: al-V State:
Phone No. Zip Code: O Fax:
E-Mail: Phone No � Z
Fill in fee simple Title Holder on next page (if different E-Mail . (1
from the Owner listed above) State or County License ,&( I3noo d
If value of construction is 2500 or more,a RECORDED Notice of Commencement is re ui e .
If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.- �
SUPPLEMENTAL C«�N57 UCTION LIEN LAW INFORMATt�N:
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 ao posted on the jobsite before.the first inspection. f, o intend-to obtain financing, consult
with len o • n attorneybefore commencingwork or recor ' oti of Commencement.
i
i Owner/Lessee/Contactor as Agent for Owner SiaWgture Contractor/License Holder
r
n
STATE OF FLORIDA �t� '� e� STATE OF FLORIDA 1
COUNTY OF ,cam�� COUNTY OF C,IIL
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
P y ical Presence gr Online Notarization cal Presence r Online Notarization
this ay of 2020 by thisP si ay of 2020 by
ckArom )MY? rR cl_,halo
Name of person making statement. IName of person making statement. I
/
Personally Known OR Produced Identification Personally Known 0 Produced Identification,/
Type of Identification Type of Identification
Produced Produced
(�/v ELLEN VAUGHN-
(Signature of Notary Public-State of Dehcla (Signature of F i>r��t ml o i� ;)270079
=, + Commis
IIVP ELLEN VAUGHf� My Commission Expires
Commission , °A:; rida No(��a ublic Commission N fOFF�� October 22
=* Commission # GG 270079
�9JF oP My Commission Expires
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REVIEWS FONT O ING S PERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED,
Rev. 5/6/20