HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATIONTO BE ACCEPTED
Date: Permit Number:
91To RECEIVED
o r _
L.. o a -- — JUN 0 4 2011
Building Permit Application
Perrrlltting Department
Planning and Development Services St,Lucie C, o�ty
Building and Code Regulation Division Commercial Residential zC
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 1 y sFt-1c'T DYz% V'�F- ' IPQS
Property Tax ID#: _ �2� 7 �� �`�' Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
4't`eV �P(`4T`'e y go f>,co-k 3w i ill
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 V"'Plumbing —Sprinklers —Generator —Roof Pitch
.Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 4000. 00 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: _ CONTRACTOR:
Name P-a molt X!L2)t Name: ViS—WiY1 (7�Q
Address: a'ba-1 Company: �1��t�naQc�Irr1. P`�dbbCOl C�
City: psL• ';\ , V ivy r' n State Address: t;S4 4Z%: 3 WOW eX E,\k'-kW
Zip Code: Fax: City: QSL` Stater
Phone No. Zip Code: g4q-( 3 Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) 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 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 inspectio If you i tend to obtain financing, consult
with lender or an attorneybefore commencingwork or record our NAtice of Commencement.
e
Signature o Owner/Lessee/Contractor ent for ner Si6at6 trac re of Conto Aicense Holder
STATE OF FLORIDA STPVTE OF FLORIDA
COUNTY OF COUNTY OF
Sworn to(or affirmed)and subscribe efore me of Swo to(or affirmed)and subscribed before me of
Physical Presence or line Notarization Physical Presence�or Online Not 'zation
this day of 2020 by this T day of ✓C Ae
Name of perso/makin tement. Name of person making statement.Personally KnoOR Produced Identification Personally Known OR Produced Identi it6$ onoo
Type of Identif Type of Identy1'fi atio 'a a c
Produced Produced OD— q —a. Z D
(Signs re of Notary Public-State of Florida ) (Signatur otary Public-State of Florida)
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C mission No. (Seal) Commission No. Zs33S (Sea
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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