HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
yr 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: c 6
�.a.�
�a� a
f ,,
Address: �;52n f"e i nc��c i �� z, _ PsL Fi 3 -oe2.
Property Tax ID #: 3H2UO` (o • '1Q3 • -rm .0 Lot No.310
Site Plan Name: Block No.
11 . - =TOI'VM - - Tel rol-Ir�1r9p[4:'i-7row 9&1MF1Fly►iPAW. LI�
ilraaA:� 20-• of cn • C 6
New Electrical Meter Second Electrical Meter
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: $ 212-A Utilities: —Sewer _ Septic Building Height:
Name P)QfW rQ l cLune
Address:12at) SSOCdPiCr, G>'
City: PDr+ S* U---C-i e— State:fll
Zip Code: 34Q52 Fax:
Phone No.--n2• ��C(• �lQ
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: L0(jnj,:n-
Company: D4p&r-CAr
Address:ll3C5 NL0 G70fGYIs-L-- L71'
City: "'z+ wc- l e State: FI
Zip Code:--3L4Ct 8 (o Fax: `T12 •L4 UO ]iGI S
Phone No `-n-Z - L-1 L,00 - l(o30
E-Mail tl�.1&—DDGCt1-Crr-C%CS�, -Co
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.
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 attorney before commencing work or recording our Notice of Commencement.
Signature —of —Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF _54'%n+ Lam° Gi G
STATE OF FLORIDA
COUNTY OF Ylii dr� �ie
Swgrn to (or affirmed) and subscribed before me of
V Physical Presence or. Online Notarization
this � day of Dn� 2020 by
Sworn to (or affirmed) and subscribed before me of
L/ Physical Presence or Online Notarization
this _?O� day ofi7�� �— 2020 by
(f Wit) 0
4� d lryl f e Ur' r'Uce
Name of person making statement.
Name of person making statement.
Personally Known I/ OR Produced Identification
Personally Known '✓ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced/
/
(Sign• ture of Notary Public- State of Florida)
�% ( moo~; ; ,��,o MlCHAEL W
Commission No. 't i/T 7�� j * * Commissilw#HH
mr Expires February
Bomm"ThrusudwN
(Signature of Notary Public- S ate of Florida )
MICHAEL
mission No. * I � #MH
. 2025 �, t Expkes February
savior �rR 0�� SWAM ThrUPJW
2
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.