HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / (�
Date: 3- 2-11 - 201-I Permit Number: O/,y�
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Building Permit Application' �ECEtVED
Planning and Development Services 1U11
Building and Code Regulation Division Commercial Residential MA nt
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2300 Virginia Avenue, Fort Pierce FL 34982 permitting D2a
Phone: (772) 462-1553 Fax: (772) 462-1578 Sc. Lu"-you t
PERMIT APPLICATION FOR.;
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PRQOS�D�,M'PR°Oj/E,MENT LQCATIOiIV
Address: //��Ea'w 4 r�5
Property Tax ID #: 2 4 2 0 " Lo 62 - to -000— io Lot No.
Site Plan Name: Block No. Z.
Project Name:
New Electrical Meier Second Electrical Meter
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: _
Cost of Construction: $
_ Generator
_ Windows/Doors _ Pond
Sq. Ft. of First Floor:
Roof Pitch
Utilities: —Sewer _Septic Building Height:
(7WNER/LEin
CONTRACTOR
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Name brekNda- Ma0dO.5
Name: r� ✓!tz ij
Address: 2-H 4 T,:!Z�quo►S A"-
Company:-, r&Y, 6vac✓►J C'CIj J .
city: irk Pierce State:,�L
Address: 1,1 7
Zip Code: c3!b qj0 Fax:
City: yi State:
Phone No. '77,9 35 3
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Zip Code: 3 7 Fax:
E-Mai1: lra,A a —. (Na.C, P, �4a..V-:60 • cowh
Phone No 7 Z 3 " .3
Fill in fee ple Title Holder on next page (if different
E-Mail % S. C v1J CdrJ f✓tom �al� l�
State or County License
from the Owner listed above)
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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.
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DESIGNER/ENGINEER: _ Not App
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address: '
City:
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 rbspects, 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 nop-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 comfiencing wok or recvrdinP your Notice'ofi0ommencement.
Signature of Owner/ Lessee/Contractor as
IIISTATE Fl.
COUNTOY OF
Swoy(to (or affirmed) and subscribed before mle
a/ h sical Presence or Online Notari�a �_
this day of CAv -C 2020 bym 3 o D
3'Om
Name of person making s atement. o•'k TcaG)0Personally Known OR Produced IdentiType of Identification � w O
Produced y c p
ure of Contractor/License H
STATE OF FLORIDA
COUNTY OF
Sworn(or affirmed) and subscribed before me of
✓Physical Presence or Online Notarization
this, Q day of JA4_ 202.0 by
Name of person making statement.
Personally Mown OR Produced Identification
Type of Identification
Produced 17bll
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(Signature of Notary Public- t'e of`Florida )o� NOTARY
ftaELre of -Notary Public'- Sfate of Florida)
a c STATE
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Commission No. C464363 768 (Sea
F FLORIDA
j ? Comm#
s�NCE
GZMa lion No. (Seal)
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19�® Expire
817/2023'
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REVIEWS
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
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COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
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DATE
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RECEIVED
DATE
11-1
` OCOMPLETED
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