HomeMy WebLinkAboutPermit AppAIIAPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date T-/L- 2l
/q" fe # Permit Number
37r/ _2?r_ ///
Building Permit Application
Plonning and Development Services
Building and Code Regulation Division
23A0 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (7721 462-1578
Commercial Residential X
Add ress:0 5t ,7
Property Tax lD #
Site Plan Name:
qr//- s/0- 0/03 -ooo-o LatNo. i{
//I 4 Block No.
Project Name
ne
New Electrical lVleter Second Electrical Meter
Additional work to be performed under this permit - check ali that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _. Sprinklers _ Generator
--_ WindowsfDoors
Roof
Pond
Pitch
Total Sq Ft ofConstruction: 6L Ll Sq Ft. of First flror, /O /
Cost of Construction: $ )gf2."a Utilities: $.**, -
Septic Building Height:7ff
lf value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
lf value of HAVC is 57,500 or more, a RECORDED Notice of Commencement is required.
PERMIT APPLICATION FOR pero /,"f;o,i
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aaaress: 22lO 67 fh Jf
PhoneN.. fll-wd-37u
Fill in fee simple Title Holder on next page { if different
from the Owner listed above)
State: p.f
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finrt r)//eCity:
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Zip Code
E-Ma
Name
L/7/0 8 Fax:
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State or County License
Fax:77t -13 2 -2/q/
Name
Phone No
E-Mai
St, Luclr
CONSTRUCTI ON I N FORMATION :
PROPOSED I M PROVEM ENT LOCATION :
DETAILED DESCRIPTION OF WORK:
OWNER/LESSEE:CONTRACTOR:a
Phone7ip
_ Not Applicable
City:
Addres
DESTGNER/ENGr
Name:
_ Not Applicable
State:
Phone
Applicable
Phone
eity
FEE SIMPLE TITLE HOLDER:
Name
Address
Phone:
Na
Address:
City
zip:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and in
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Countv mal<es no reoresentation that is erantins a oermit will authorize the oermit holder to build the subiect structure
which is in conflict with anv applicable Home Owfiers Asiociation rules, bvlaws or and covenants that mav restrict <ir prohibit such
structure. Flease 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 follov'ring buiiding permit applications are exemptfrom 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 [\otice of Commencement must be recorded in the public records of St.
l-ucie County and posted on the jobsite before the first inspection. lf you intend to obtain financing, consult
with Iender b mmenci work or recordi urN Comm
indicated
Si 'actor as Agent for Owner Signature of
STATE OF STATE OF FLOBIDA
couNTYoF I i l,r r ICOUNTY OF
ed) and subscribed before me of ) and subscribed before me of
or _ Online Notarization ar 0nline Notarization
2o2A by this Akt day of 2020 by
t\c)ar*, <^"+l-,
Name of person making statement.Name of person making statement.
Personally Known OR Produced ldentification V/
Tvoe of ldentificationproauceaEltrlz{ a- D t-
Personally Known OR Produced ldentification
Type of I
P
l'"ha,*r,Ar"^-ft lrfu
Signature Public- State of
ffi'
{Signatuie odf.f otrrV Prnti.-MATTIS
MARY LEE HH 089498
#+los q+q g Commission # HH
Expires March 6,
Cornmission Nc.mission No._ (Bai$s March 6,2025
8ond6d Thru EudgetNolsry SwicasOF
Eonded Thru
0n
REVIEWS FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
t
SUP CONSTRUCTION LIEN LAW INFORMATION:
MORTGAGE
Na
zip:
COMPANY: _Not Applicable
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