HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE.COMPLETED FOR APPLICATION TO BE ACCEPTED O 11/�
qo
Date: Permit Number:'�,�(
Building Permit Application
Planning and Development Services
Building and code Regulation i Division Commercial . Residential,
2300 Virginia Avenue, Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR:
=PROPOSED"IMPROVE"M'ENT LOCATION.
Address:. . -
2S �'
Property Tax I D#: y`"t f � Lot No .
Site Plan Name: ;; . Block No.
Project Name:.:
DETAILED DESCRIPTION OF WORK:
I I 1�" n� 0 �i(,r1 V i11;11Yi ML l i i��G�l�. Q 0 ll� Q, QW4, fi;YWA\i`()
J
New Electrical Meter.. -Second Electrical Meter.
CONSTRUCTiQN INFORMATION
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:$. 0 15, Utilities: _Sewer _Septic Building Height::
OWNER/LESSEE = CONTRACTOR:
Name:.p=itl l,aUvfe�(lC ;
Address U Company ibi
Cit
y .. State: ��,„ Address [S '�'
Zip Code:; '? 1 Fax _ City:.StSAC kb. State 28
Phone No t` =C. {"1 (' Zip Code: ry11� Fax:
'l
. ,
E-Mail: ' Phone No��
Fill in fee simple Title Holder on next-page(if different E-Mail t(I l.til (Ai`i�V'll
from the Owner listed above) State or County License Q ZLO Z
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.
i
SUPPLEMENTAONSTRUCTION LI L C FN"LAW INFORMATION:
_.
DESIGNER ENGINEER: Not Applicable
[ _ MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: ._ Address:
city*.- City a St t e
Zip:. Phone
Zip: Phone:`
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
_
Name:. Narrie:
Address: Address: `
City: City:
Zip . . Phone: p:.
Zi 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.,LucEe:Gounty makes'no representation:that is granting a permit will authorize'the C�er nit holder ta:build the;subject structure
wfirch is in_co ,hct with.any applicable Marne Owners Association rules,, ylaws.oran cavenantsahat may restrict or prohibit such
structure:Please consult with"your Home:Own ers,�lssociation and review your d0ed,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 Commencerrieot`must be recorded in the public records of St.
Lucie Count and"asted`onthe 'obs'te before the=first-ins ection. If you intend to obtain financin consult
Y P J r. , p Y g.
alit' enderror an'a a before camniencin work_or recording your Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/Lit nse'Holde ':
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF MAU ' COUNTY OF - MG'('A'1`n
a
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 J(1,day of,. 2020 by this_1a day of `E 2020 by
s ;
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
Pr used Produced
y
I1
(Sign t e f t P t ► ure,to ary.
WafF pub(
► ry�
nr . soft of b
Commission No H 113a*HH 0933 Common N -
REVIEWS. FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
-RECEIVED
DATE -
COMPLETED
_,Rev: