HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date %I ) I Z- k Permit Number:
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' Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: WItjDCu" 4 F4erwca-1 bnoiz- "e -r
PROPOSED IMPROVEMENT LOCATION:
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Address: I ZZ (,` oe6w AE5S CT 14U-1 cM igsoN xsia"ab 0 3gC)J9
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PropertyTaxlD#: 0119- Q= _Z Lot No. C
Site Plan Name: 'i� U 1� 0006 Block No.
Project Name: S14AP7M14
DETAILED DESCRIPTION OF WORK:
LO :1-� Ski cl' WG7\
New Electrical MeterAIA_Second Electrical Meter Pf l A
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 Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ ISooa Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name o A ShA
Name:
Address: IIVZ QLkj C 'LT,
Company: liWrvmcavD cG"J6T4uC60N
Address: 2.30S t ,Qet- 40r 1/nm3ckt- Ljl
City: Stater
City: f6zr, ?l,0 .0 (L State:
Zip Code: 349`(g Fax:
Phone No.
Zip Code: 349SI Fax: )7Z—,4Vj-G3Z5
E-Mail:
Phone No 7 )Z- Z t lo- t\ %,9
1
Fill in fee simple Title Holder on next page ( if different
E-Mail -Q Nj m� b Z4 6' %"k 3oA,, . 1JeT
State or County License C.IZL 13 Z. 7 Z U
from the Owner listed above)
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: Law5o,J
Name:
Address: 1s u w. 50 sT.
Address:
City: M0,1 e Stater_
City: State:
Zip: 3314p(o 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 bylaws
rules, 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 exemptfrom 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 inspect' tend to obtain financing, consult
with lender or an attorneybefore commencing work or re inia r N ce of Commencement.
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Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contra /License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OFF ��
Sworn to (or affirmed) and subscribed before me of
(or affirmed) and subscribed before me of
Physical Presence or _ Online Notarization
%rn
sical Presence or Online Notarization
_
this_dayof 2020 by
tday of 2020 by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally KnovD< OR Produced Identification
Type of Identification
Type of Identification
Produced
;oduced \/�}
(Signature of NotaryPublic-"Sk idL4mmAsw i GG 198133
(Signature of Notary Public- State of Florida)
Commission No. (Seal)
E+pirs4Mh'ch20.2022
Commission No..'J—L�4n"� (fi'1 tlj1$"b'
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