HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:/ Permit Number:
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Building Permit Application \
Planning and Development Services 0 AI30ald
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Tort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 \
PERMIT APPLICATION FOR:
PRFOPOSED IMPROVEMENT LOCATION
Address: 3 0
Property Tax ID#: - �/ 0 11�d/ Q•lj f' Lot No. \
Site Plan Name: Block No.
Project Name:
DETAILEb DESCRIPTION:OF WORK \
v
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION
Additional work to.be performed under this permit—check all that apply:
I :
-
Mechanical Gas Tank Gas Piping Shutters Windows/Doors .Pond
_Electric _Plumbing _Sprinklers _Generator -= Roof ) Z, Pitch
Total Sq. Ft of Construction: Sq, Ft. of First Floor:
Cost of Construction:$_ Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE :CONTRACTQR
Name . �E4-IL L=/� r�frJt��� Name:
:Address: Company:
City: State: Address:
Zip Code: Fax: City: State:
Phone_No'_ 7 j� Z/// �/ �_ Zip Code: Fax:
E-mail: � ��I� r� Phone No
t ..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 R ORDED Notice of Commencement is required.
If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required. =J
1SUPPLEMEt�1T`AL�CC�N-5"�'�2UCTlUN L��a11�� ;W"� ORMATI.t��t ��'y,y��` ���+�j���.• - -� ��,.'`1r,��'k��:��' �'�*�''a<fsz=
�;'�....r,C'' ��.., r�+`._'t,:,.3�4k.�R��,.- _+,_��.��,.F:�..f:,... "'�";v,,a'::::�-,vip=d#t�,st �-�.��*'�';red..^� `^s .r•-'S� < .� : r�2�.,ff,,.�ta � �r�`�'�.'1r Yc- .� 1L� uP -F.
t.,n J?,.e'• ..��P'ST ��.�+1Y'•Y'.4:.. .�� .ram-:4v,�,, f. ._�.:;$ 4Y�.1'..... t - ..`.'� .. .,.).",.'.M,
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.
1 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 commencinR work or recording our Notice of Commencement.
` Signature of ner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
I t -
STATE OF FLORIDA / STATE OF FLORIDA
COUNTY OF l:�t!r-G�, 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
this-day of - 2020 by this day of ,2020 by
Name of person making statement. Name of person making statement.
Personally Known_S4 OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced'-- Produced
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Commission No. 2 O/ > (SeEiMATION
i A10- (Seal)
utian GG 250130022
REVIEWS FRONT ZONING ATiON SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE '
COMPLETED
ev.5/6720