HomeMy WebLinkAboutBuilding Permit Application I
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 2lb lD-D-(0
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division C011'ilT&vial Residential .
2300.Virginia Avenue,Fort Pierce FL 34982
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Phone:(772)462-1553 Fag:(772).462-1578
PERMIT APPLICATION FOR: y�ow-C
PRQPOSED.IMP;ROVEMENT LOCATION
Address: ��' c► •
Property Tax I D#: 130 6 -.Soo 03aa 000-G Lot No.Lf." _ '
Site Plan Name: Block No. tool
Project Name:
DETAILED DESCRIPTION:fJF
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2.Qjr *¢t 4.1L�'�s'}1 e%5 c DeAr 0^6 "r15+ a I 1 VN1.,W C\► V41,0-A Mk on 6
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New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATI,4N
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank —Gas Piping _Shutters _ Windows/Doors —Pond
Electric r Plumbing _Sprinklers _Generator Roof 5 la Pitch
Total Sq.Ft of.Construction: 02" 9 Sq.Ft.of First Floor:
Cost of Construction:$ 1 isd0 Utilities: _Sewer Septic Building Height:
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OWNER/LESSEE t °CONTRACTOR
Name . iA a QJ Name: ja -
Address: iNe2d6 qa/%)A Company: ro fiso--; cAr-s-1 Rot.4i1n4
City: U 1e.c eA, State:FG Address: I �k\6
Zip Code:JggSI Fax: City:5�JcV S� . J,satA - StateNt-
Phone No. ci I,- In aD - !7c/4 Zip Code: sis%u Fax:.
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail TC'4ca® ► [e.Qr� • err.
from the Owner listed above) State or County License CC.-C.-43NZ&Gk
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 1s required. .���LO
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6 5_:G 11,A'01, �"I.�ON t' -WEM,
DESIGNER ENGINEER: T Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address.,
City: State: City:. State:
Zip: Phone Zip: Phone:
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FEE.SIMPLE TITLEHOLDER: ,.,,T 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.
1 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 an 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 aply.
In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work j
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-residentlal 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 commencen work or recording our Notice of Commencement.
Signature of Owner/Lessee ontractor as ent Signatur of C tr or/License Holder
STATE OF COUNTYOFORID 4. STATE OF COUNTY OFORID Tt. Zdat
00-
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Sworn to(or affirmed)and subscribed befor §fJ Sworn to(or affirmed)and subscribed before me of Z
V% Physical Presence or Online No r' �b Physical Presence or online Notarize 'o@ e 0
this�day of Su�4 2020 '=Q o this I� day of 5v� .2020 by 3 <
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Name of person making statement. m N. Name of person making statement. D
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Personally Known x OR Produced Id ti Personally Known W. OR Produced Identifica o a3 113
Type of Identification 'o Type of Identification
Produced �' ro INProduced zi M
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(Signature of Notary ublic-Stat Florida} (Signature of Notary ic-State of orlda}
Commission No. G6a`1S�c�i')— (Seal) Commission No. (Seal)
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REVIEWS FRONT ZONING j SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED j
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