HomeMy WebLinkAboutBuilding permit app building 1All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
` E Building Permit Application
Planning and Development Services
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:Ve
PROPOSED IMPROVEMENT LOCATION:
Address: J v5
Property Tax ID#: ozo1 —
Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
ivew tiectricai Meter Second Electrical Meter W ntLi)d.i'5 I to Cru[Q, ,
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 5q- Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ l)1 Utilities: Sewer Septic Building Height:
OWNER/LE.SSEE- Chuo, CONTRACTOR:
Named yd eiI-r lie�11rrX� )��Sbl i --) "2Li Name: 7C iJ
Address: 55 `f' ac.le .A_�rc Company: p Y: Lc'C,
City: E e,(;rI,[;t State: Address: 1 11 Iq S),,) Sj']'10CeGi 0 67V'Cy
Zip Code: '3 �`� Fax: City: -+ .S f L! t
State: !"'1
Phone No. SU I [p 5 g l I S Zip Code: J Y j Y y Fax:
E-Mail: Phone No `77a 3Y y- l r i 3
Fill in fee simple Title Holder on next page ( if different E-Mail (' S �� ,r► , I (,�,-vl
from the Owner lister! above) State or County License C C C. I T3D_� I
If value of construction is 2500 or mnre- a RFrnpnFn __ __-.
------------�•-- vn1n1VIlUUMCII%. W Ft2quire0.
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
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:_
Address:
City:
Zip:
Phone:
— Not Applicable
MORTGAGE COMPANY:
Name:_
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip- Phone:
Not Applicable
State:
Not Applicable
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 your Notice of Commenrpnriprit
Signature of Owner/ essee/Contractor as Agent for Owner
Signature of Contract Lice se Holder
STATE OF FLORID STATE OF FLORIDA
COUNTYOF �t�i✓� C_ '
COUNTY OFF
Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
✓Physical Presence or Online Notarization ysical Presence or Online this 1 _ day of Notarization
2020 by this J day of . c c f Q 2 No ri
Name of person making st tement. Y Y —P r
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary PybJj - SLUP nf r-i,,.:a., y
Commission No.
„rr
CONSTANCfw I'FiOUI._X
.r State o(Tljl)da-Notary Public
_* * Commission # GG 258328
=� My Commission Expires
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REVIEWS � FRONT
COUNTER
DATE
RECEIVED
DATE
COMPLETED
ev. 5
Personally Known v-' OR Produced Identification
Type of Identification
Produced
(Signature of Nota PV*' to
State of F N F PROULX
Commission No. : - com lore _N fary ptibli,
missro n 25
°F��;, y Commis 8326
Pires
Septembers I R xn,,,
ZONING SUPERVISOR I PLANS I VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW