HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE-INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
, a
Date. � Permit Number:
6..-4 LL.w✓.+t� mow'" ..
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential t%
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
PRfJPaSEQ IMPROVEMENT LOCATIC N
(..' .
Address: C\t o
Property Tax I D#: ts oi— ca 1 �eL4 r QOu--9 Lot No.
Site Plan Name: �— Block No.
Project Name:
D 1`AILED QESCRlpfiON-OE WORK
0 l�`n i
New Electrical Meter Second Electrical Meter
CONSTRUCTlN INFORMATIOV
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: $ ? .00 Utilities: _Sewer _Septic Building Height:
QUtINER/LESSEE CONTRACTOR
Name Cn\t Name: �� C���� G�nG.�l t�,tL
Addre}: Lk0l Company:.Vmsw C Co '�Mq kt'X a tic
City: \ State: Address: 1,,
Zip Code: �� \ Fax: City: \f Hy tUo \K(71CY1 State:
Lone No. ���' _ ��� Zip Code: `�2%pU Fax:
il: ��Co\R....0ko\cr\ zQVGthaO ,C� Phone No ��1. 'j�Ll '30S
Fill in fee simple Title Holder on next page(if different E-Mail_ 40U 0)t,t\I '&'OSC@ auk-100K .[
from the Owner listed above) �(/'E �t 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.
SUPPLEMENTAL CONSTaUCTiON LIEN LAW lNFORMATifN r
. .
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.
ature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA c, ' STATE OF FLORIDA
COUNTY OF �,6�jTl u CIA, COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed) and subscribed before me of
Phy sical Presence or Online N arization Physical Presence or Online Notarization-
this y of 1202F by this day of 2020 by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced ' I V Produced
(Signature of Notary Public-StaTe of Florida ) (Signature of Notary Public-State of Florida )
'Commission No. Seal) Commission No. (Seal)
P�OS ��,i ELLEN VAUGHN
` pRY
�2 Bo:
(+�Stat
Co mission # GG 2700 1c
REVIEWS F M IN1PNGion x$WXR ISOR. PLANS VEGETATION SEA TURTLE MANGROVE
-. _ _ 242 22P REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 6 20