HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED '
Date. Permit Number: to v
BUilding Permit Application
Planning and Development Services ' /
Building and Code Regulation Division Commercialy Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED I.MPROVEMoEENT.,LOCATII►ON: �7 -s� %� /1�y
,aa��.«. 919/n S F /�/%JG)1/1 //n 11A ; 7 14-0 , 1 T�t/li✓_.n /�Y//./'/n f-1 .514 % i7
Property Tax ID #:
Site Plan Name:
Project Name: 5w7T bru e-
Lot No.
Block No.
DETAILED, DESCRIPTION' OF WORK:
Goodo 426:�r o od e / , Vowi✓r �y,� , [� �I�y►c=fs . Ca��lTc-� ��, s � i o f
5h0L0�� he c PW1MC �rf �le o/)
New Electrical Meter Second Electrical Meter
CO.NSTRUCTI.ON I'NFORMATION
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 Sq. Ft of Construction: J -1<9 Z Sq. Ft. of First floor: / 5,51 Z
Cost of Construction: $ qx. 000 Utilities: —Sewer _Septic Building Height:
ESSEE : ;Y
OWNER/L, ,..
C ONTRACTOR:
Name 0"612—
Name: It /Sf20 M0r2E1Y4
Address: &W 5> (Q660t,7 f%. -,t—
/4A
Company: &d4;M i I��i%6'6Vv►zbvrlS; Lf;
,,
City:..T-
f:1n2- i& l e 6o,&7 State:
Address: SY 2!± L `9kC-. rQiO
Zip Code: 3 G1 Fax:
City: cack)A ut &�-e State:
Phone No. 234 24B oo 2:�
Zip Code: 33 Q J-3, Fax:
E-Mail: �,nAi �® Cam+
Phone No 7�I2 • GZG G6 S-o
Fill in fee simple Title Holder on next page ( if different
E-Mail yokf h5 _5eQ1 'r C0 (0 g v141I , (,Q4ll
from the Owner listed above)
State or County License G G 15�40,51
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:
EER: X, Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLEHOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: ,Not Applicable
Name:
Address:
City:
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 attornev before commencing work or recording vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF •'(r L r_li;, I COUNTY OF _ L.�
Sworn to (or affirmed) and subsc "bed before me of
Ph rcal Presence or=Online Notarization
this 1 � Nay of `ylt , 2020 by
Name of person m ng statement. /
Personally Know OR Produced I ntification V
Type of Identifica 'on
Produced I 119
(Signature
• = Commission # GG 15819
My Comm. Expires Nov 7SE
flondbd immugh Naflonai No'aryAssn.
Sworn to (or affirmed) and subscr' ed before me of
PhYs'cal Presence or Online Notarization
this 1 ! ► ttay of `�Jd�-� . 2020 by
t
Name of person maki statement.
Personally Known OR Produce Identification
Type of Identifiici n
Produced
V' • `_ Commission # GG 15W'g —
COmmisS 11 e= Comm. Ex Tres Nov 7, 2021
'+ oc�.°��• Bd'nde'd tfifdeQfi Nedonel No:eryAssn.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20