HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
• ` ... 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:
Address: v) (srQen va �rc� L 3 98'a
Property Tax ID #: Lot No. —
Site Plan Name: Block No.
Project Name: ep Y
New Electrical Meter Second Electrical Meter
Additional work to -be performed under this permit —check all that apply:
_,Mechanical _ Gas Tank — Gas Piping
_ Electric _ Plumbing _ _ Sprinklers
Shutters Windows/Doors Pond
— Generator ____ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ L 00 Utilities: — Sewer —Septic Building Height:
Name Pe t' C 6 k { ... _.
Address: LIo �� 'w�a
City: ' e rc-e- State: ILL
Zip Code: Yq q Fax:
Phone No. ,2.-
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: J70&29st!Ji,e
Company: CQA,#..1 ti
Address. ��d,). L�t.`r sCiGvs�l,
City:_ .,._. Stater
Zip Code: _LJ f/ 2"_ Fax: 7 2?- V,4 /-
Phone No ? -
E-Mail Q 4ew, o ftl
State or County Licensesec S'/,re
,.nsa io e;KM Of mere, a Kr LU#CUCU mnice of commencemett is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
-- _,� .�,� nNrrusur� MORTGAGE COMPANY:
Name: Not Applicable
Address: Name:
City: Address:
State: City: State:
Zip: Phone Zip:. Phone:
FEE SIMPLE TITLE HOLDER: Not ApplicableTBONDINIG COMPANY:
Name: Not Applicable
Address: ame.City: ddress:
Zip: Phone:h►:
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 1 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 commencin7 work or recordin our Notice of Commencement
:tor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
savor o(or affirmed) and subscribed before me of
P ysical Pres n e or Online Notarization
this day of 2020 by
�m i 1 -11,1
Name of person making statement.
Personally Known OR Produced Identification L----
Type of Identification
Produce
(S g re of Not Public - Sate of Florida )
�o p"� TAFiA G. SIMMONS
Commission No.{1 tf ply 3 S� *soel) Commission # HH 0243
oe Expires July 27, 2024
STATE OF FLORIDA
COUNTY OF Ll,,A
Sworn to (or affirmed) and subscribed before me of
L--�Y��1sicai Presence or Online Notarization
this —L. day of { rr 202 f by
Name of person making statement.
Personally Known OR Produced 1 entification
Type offidenti nation
Of
Of
mission
paq,!) TARAO.SIMM
al ornmission # HH
oe Expires July 27,
op p�Te' Bonded ihiu Budget Note
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