HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 8 9. Permit Number:
91To LRl�_'1 CE � RECEIVED
o --- APR 2 2 1011
!f Building Permit Application Ponn1tt1.rg Departmei
Planning and Development Services St. Lucie County
•• -
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMP•ROVEM•ENT, LOCATION:
Address: D% icu—&O ' J�.� Y� ..V+- Ff eyZe., L 3 Ll
Property Tax ID #: _S 10 - 570;L -. 0'o o r oo o C Lot No._
Site Plan Name: L y, Block No.
Project Name: �7 Z�7i�'1►� t CIA— DO C,�
i
DETAILED DESCRIPT_ ION -OF WORK:
lodaj- A
New Electrical Meter Second Electrical Meter
_CONSTRUCTI,ON INFORMATION:
Additional work to be performed under this permit —check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
V/Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ O , 00 0, Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:: • :. _ ..
CONTRACTOR:
Namevfw I e
b/iName:
Address:DO j S•0,1
Zh I,%xtom ✓-
Company:
City: 1�9✓ ?(wUL.. State:(
Zip Code:3 01 Fax:
Phone No. (� �s� a
Address:
City: State:
Zip Code: Fax:
. 44oKe No
E-Mail: fi
Air-( Ck--Z eA C oOVO✓0,�r�
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
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 -CONSTRUCTION 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 concurrericy 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 orbattorney before commencing work or recording your Notice of Commencement.
of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLO
COUNTY OF.
Sworn to (or affirmed) and subscribed before me of
Y Physical Presence or Online Notarization
this day of M�y
ISO- 'A Rlt-O&hrA,
Name of person making statement.
t
Personally Known \,L OR Produced Identification
Type of Identification
Produced _
M. • KAREN LIBRIZZI
Commissi ' MY COMMISSION # GG gf)
',N ��__
=�• :oQ: EXPIRES: July 10, 20 3
Bonded Thru Notary Public Underwriters
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of 2020 by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
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DATE
COMPLETED
Rev. 5/6/20 1 V31