HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE CQM` P.LETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
L7� LLUCC➢L
a, �' a U. Building Permit Application
Planning and Development Services
Building and Code .Regulation D!vlsion Commercial R,ESidehtia)
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:,(772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR: ���
PROPOSED IMPRO MENT LOGATION:`?
Address: Yus tay4ow
Property Tax ID#: 3c404— Lot No._ a.3�a
Site Plan Name: . Block No.
Project Name:
DETAILED DESCRIPTION OF,WORK
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New Electrical Meter Second Electrical Meter
CONSTRUCTION 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:_�i Sq.Ft.of First Floor:
Cost of Construction:$ mc.) Utilities: _Sewer _Septic : Building Height:
OWNER LESSEE: CONTRACTOR
Name . 4 Name: �.. i-I ; ` O
Address: as ow
Comp' n . a
City: Cst, Stater Address`i- t,✓
Zip Code:aqct & Fax: City. Stater
Phone'No. ?II,,- Bvp 6 11.010 Zip Co Fax:.
E-Mail: Phone No - 3 20
Fill in fee simple Tifle.Holder on next.page(If different E-Mail iz L rYt �.
from the Owner listed above) State or County.License 4
If value of construction is 2500 or more,a RECORDED Notice of.Commencemerit is required.,
If value of HAVC is$7,506 or more,a RECORDED Notice of Commencement Is required.
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DESIGNER ENGINEER: _Not Applicable MORTGAGE COMPANY: ` Not Applicable
Name: Name:
Address: Address:
City: State: City:. State:
Zip: Phone Zip: Phone:
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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 Comm cement.
Signature of Owne Le e/ ntr for as Agent for Owner Signature of C ntra r/Lice a Holder
STATE OF FLORIDA STATE OF FLO IDA
COUNTY OF COUNTY OF C.U&S°lam
Sworn to(or affirmed)and subscribed befo S oo'n to(or affirmed)and subscribed before of
V—Physical Presence or Online No am ati "Physical Presence or Online Notari ticin4
this_,___day of 2020 by this_day of 2020 by
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Name of person making statement. 3 - < Name of person making statement, 0 0 0
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Personally Known OR Produced Id ti1csti�° Personally Known OR Produced Identi aii S
Type of Identification z m- G) Type of Identification in Q g
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Produced p ° v,0) D Produced > > P
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N O N �.P1
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ignature of Notary Public-State o orida (Signature of Notary Public-State4f Florida} J 1 zt T o
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Commission No. K (Se I}N N w Commission No ��� �a► {Seal) N N w
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REVIEWS FRONT ZONING ) SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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