HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ',n^ %�(�(�
Date: Permit NumbercQIV& -COS
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:
Property Tax I D #:
Site Plan Name: _
Project Name: _
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORIVIATf0N :,'
ON
Lot No.
Block No.
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:
�`�j_
Cost of Construction: $ CJ T/u` 0 Utilities: —Sewer —Septic
Building Height:
OWNER/LESSEE': ;. `'
CONTRACTOR
Name
Name: '
Company: o f ~ ez7 k
Address: WYK 24
City: PR Stater
Address:
Zip Code: Fax:
City: 6 ( State:��,
Phone No. 6 3 � 0��3
Zip Code: Fax:
E-Mail: �l r a
Phone No
Fill in fee simple Title Holder on next ( if different
E-Mail l ^ r i
from the Owner listed above)
State or County License , C'
YV�
-q1-1 Uu„0«ucuu11 ib zauu or more, a ncLuKwtu ivotice orcommencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
NJP�'�LE�E��'Al�� ��{Y,✓'+w;����_������� tli� ����� � ��'i�+'�``5�'7fk f�(, 4°�i�'�{�.^�c l'sa y�.f�y�.�
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 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 (�L)ii�
COUNTY OF J�
CO OFORIDA
U7 W
Swo to (or affirmed) and subscribed before me of
Swor o (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
_ Physical Presence or Online Notarization
this _ day of . 2020 by
this _ day of 2020 by
Name of person making statement.
%t%%1111111 g
Personally Known OR Produced I �i
Name of person making statement.
Personally Known OR Produced Identific
JON
Type of Identification T - -T
✓L •
pe of Identificatio.1°.......•
I�od �i °
9y'
Pro uced . ti ;
Comm. Expires.
ed ®•a �. ;
.o
Omm,
ebrua 04 202
Expl
Signature of Notary Public- State of FI&idNO. MH 9544
� %
ignature of Notary Public- State of Florida No. HH 79544
Commission No. ���' •��
p
ommission N (Set�l�gj.''•...BL�..•' ,
OFF 10 ``
OF •FLD
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev. S/b/20 .
>1 :.�