HomeMy WebLinkAboutapplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: U-t Permit Number
O
k
p ° 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:
PROPOSED IMPROVEMENT LOCATION:
Address: 1b'S2S S.6CeGn
Property Tax I D #: Lkq 1k - 5-co - 000is - ow-2 Lot No. %k
Site Plan Name:Menn. Block No.
Project Name
DETAILED DESCRIPTION OF WORK:
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
v-IE_lectric _ Plumbing _ Sprinklers Generator _ Roof
Total Sq. Ft of Construction:
Cost of Construction: $ i*,TGG
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
Pond
Pitch
OWNERAESSEE:
CONTRACTOR:
Name 1()52 bt- u_
Address: br.
City: State: IPL
Zip Code: SWgS"? Fax:
Phone No. �96 2S -q
Name: &Q10
-
Company:_ LW(- "cr—1 if?lu +'staff
Address: 1= �ro.;ri� Q�l.- stw; jam,(
City: Pe-10L,Sd n�cc _ State: ICL
Zip Code: _V4L 6 Fax:
Phone N
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail LOK i C! F CD Wk0': 1 . C60^ _
State or County License FC JVj_�107 I
IT value or consiruaion is tSUU or more, a RECURIJED 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 inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTYOF COUNTY OF `,{ , LsA.0
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)
uSwor to (or affirmed) and subscribed before me of
PhyFsical Presence or Online Notarization
this " day of 7 J ,f`. _ 202J by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced�i�j'�.�"C°
Signature of Notary Public- Sta
Noiry PuAYc Stsfe O F
Commission NOT&NMIS H• Glace
a. w� E*hU 06I03 =44
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED