HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED i
Date:
04 M
191 EY
Permit Number: �l v REc�1
Building Perm it-`App.lication
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
p�em��►,it� ������t� � �t
Commercial Residential
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PERMIT APPLICATION FOR: I
Addr ss• ✓lJJ9
PropertyTaxID#: V�' � 6e6r�� B2 / LotNo.`'
L_ Block No. �
Site Plan Name:
_
Project Name: 4,�ftwu
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit— check all that apply:
pel—Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric Plumbing _ Sprinklers _ Generator Roof
An
Total Sq. Ft of Construction: 3 3 Sga q. Ft. of First Floor:
Cost of Construction: $ I�� Utilities: —Sewer ,Septic
Name -J-1
Address: ��� Q►S� f ��
City: State:
Zip Code: 14 31. Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
-Building Height:
A,Windows/Doors _ Pond
Pitch
Name:. Z' -4 ` A
company-. �ti1/L _ L�
Address:�Y, '0
City: State• ,
Zip Code: 7'!�- Fax: 72?
Phone No %72-
E-Mail (5ta-VI a44
State or County License GTS'G 039 3 T—
If value of construction is 2500 or more, a KtGUKUCU 11011GC U1 %-Ununcna " +.-'I—"
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
OW
DESIGNER/ENGINEER:
Not Applicable
MORTGAGE CO ANY: — of Applicable
Name: I71+0I U% l-od
We,
Name:
Address:
City: State:
Address: IRRA 13,1-t0110A*7 i5f.
City: Far igt-- -aae State:
Zip: 3j45,M Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
Not Applicable
BONDING COMP NY: of Applicable
Name:
Name:
Address:
Address: IV
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 permitwill authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Assoclatlonrules, 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 pro ty. A Notice of Commencement must be recorded in the public records of St.
Lucie�nty and.pos •the jobsite before the first inspection,. If you i t to obtain financing, consult
�_____ __ _,, .�,..,, .-nrv�m ,M, Vanrle nr rar•nrriina:vntir o e Commencement.
WILII CI C I
Signature of Owner/ Lessee Contractor as Agent for Owner
Signatu o Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
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 day of 2020 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 Id en ification
Type of Identification
Produced
t;ign
Produced•
ture of NIr
(Signature -
/�
} KAREN S:NIELSEN
No°`�'sStateof FloriP�j�tary Public
,�"ly, KAREN S..NIE� b�1Y Pe/�Commission
Commissio hi . `.Stateof Florida Not r lic
ommissionv GG 207484
=* •� Commission# GG 207484
y Cornmission Expires
�9,e.° My Commission'Expires 7
JuneREVIEWS
RONT ZONING SUPERVISOR
PLANS GROVE
COUNTER REVIEW', REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE 7[7
COMPLETED
ev. 5/6/20