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HomeMy WebLinkAboutBuilding Permit Application, Change of owner Sc All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 710 .` eag—i Permit Number: oil_�d O p 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 PERVIT APPLICATI ON FOR: wal PROPOSED I � �OVEME T LOC TIN, F , /_ Address: �� `RM Y ot.$AJ +' ��i�%7 / ��Z. Z `� qq(e Property Tax ID#: / Ej��© 70raGdf Y Lot No. Site Plan Name: ate'12Z y Z Block No. Project Name: DETAILED DE--S@IR TI©N aF WORK: bLzE A nd IaI+-20. New Electrical Meter Second Electrical Meter CONSTRll ilXN INFORIMAMUR, 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: /SIOG Cost of Construction: $ no � Utilities: Sewer X Septic Building Height: OWN' ER/L NTRAR: Name %f�Z/ %�i"/�L %�r� Name:_ 'ii'&,&!2 ,A,M/�l/ Address f •:� /!i'G��3�7�`�i�. 7QLL% Company:4jl�1l[//I�al> ll/�� f�5 City: Pp '. State: Address: `� 6i9� " T Zip Code:' ''a°`Fax: City:� /�� / L� - State:Z--,,'/— Phone No. A��/ Zip Code:�3 ��� Fax: E-Mail: Phone No Fill in fee simple Title Holder on next page(if different E-Mail ,�i?'� �,�/�D, /1�f iy/ S�E%11Qd from the Owner listed above) State or County License .s g /,0 > 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 C��NSTRUCTION LIEN LAW INFORMATION: 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 ofC2wner Lessee/Co.&(ra`cbor as Agent for Owner Signature Contracto /License Holder STATE OF FLORIDA STATE STATE OF FLORIDA COUNTY OF l� COUNTY OF S1XV Sw9in to(or affirmed)and subscribed before me of Swo to(or affirmed) and subscribed before me of PIhI,,��s,ical Presen a or Online Notarization P sical Prese c or Online Notarization t s �ay of 202 by this day of ti 202� by 5 Q. Name of person mak' g statement. Name of person making statement. Personally Known OR Produced I�,00rh5i��on Personally Known JZOR Produced Identification' Type of Identification ���e00®� ,AORVEL4 /,/4lt/o� Identification ` Pr d ced (i produce (Signature of Notary Public-Staff of, da�.Q e a= (S g ature of Notary PublicJ-(fit t f I r'd G3�025h ° oft I � Nqq��ryry P''pphlic State of Florida Commission No. �Sep,fiaea �� Commission No. �apf Y JgrMPIlyd ,J/ T °°° • �� a�Z\. � f y My Commission 2 281641 Ex q� Expires 12/05(2022 REVIEWS FRONT ZONING VISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. 5/6/20