HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED n /'03 6 6
Date: /4 2 1 Permit Number: RMEIVED
!j
Or LUCE MAR 16 2021
v-
s 0 Permitting department
Building Permit Application It. Lucie County
Planning and Development services /
Building and Code Regulation Division Commercial Residential 1/
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
P OPOSED IM01F. 107. LOCATRDN:
Address: �O 6 OS Af M P to r.E. T QL, PF Pf e 2 c. rZ EL 1(y
/-7
Property Tax ID #: /��U Z 13 "90 Z-0 - (�! ��, Lot No.
Site Plan Name: S1-4f �i Fit -)rL Block No.
Project Name: 1%ry4c_ 6 V/'-'fir d -
. d✓s S-t �L- T� J� q' %_, /.5 00W w*J ' 3 / X ;Z Z) L_ 6.J.r t-a r rJ
New Electrical Meter t' ° Second Electrical Meter N' o
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters Windows/Door"s' _ Pond
Electric _ Plumbing
_ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: (000 Sq. Ft. of First Floor: (0-100
Cost of Construction. $ ^LS , O� r� Utilities: Sewer-_ _ Septic Building Height: / _Z—
NWW A N IN LESSEE:
CO TRA TOR:
Name z j?a I
Name::
Address: J506D SL-gjA Pea, %►Q-
Company:
City: F'1' i9f4a -4z State: r-'-
Zip Code: Fax:
Phone No. �iS''/ - 6S^Sr- �3 2
Address:
City:- State:
Zips Code: Fax:
hone_No
E-Mail. "
E-Mail: &IJ--' ,+'''1AJLww S-L-,.rA r� Qi ✓►~��� .
_
Fill in fee simple Title Holder on next page (if different
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.
DESIGNER/ENGINEER: Not Applicable
Name:_
Address:
City:
Zip:
Ph
State
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
Citv:
Zip: Phone:_
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:_
BONDING COMPANY
Name:_
Address:
City:_
Zip:
Phone:
Not Applicable "
State:
Not Applicable
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 Co4ity and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with IPnnffiK-r or an attornev before commencing work or recording vour Notice of Commencement.
Signatur o wner/ Lessee/Contractor as Agent for Owner.
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF `J� 1Aor- JiC
COUNTY OF
Sworn (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
this J-7 day of o2% 20SI by
this day of 2020 by
Name of person making statement.
Name of person making statement.
/
Personally Known OR Produced Identificationy
Personally Known OR Produced Identification
Type of Identificat'11�,QQn
Type of Identification.)
Produced UL
low." Y>j,�
Produced
(Signature of Notary Public ate of Florida)
"�o�'^y
(Signature of Notary Public- State of Florida )
Ko_
Commission No. (Seal
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Commission No. (Seal)
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DATE
ND mRECEIVED
DATE
COMPLETED
Rev. 5/6/20