HomeMy WebLinkAboutBuilding Permit All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `� )
Date: Permit Number: �` / b47
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Building Permit App1ication ,un.:,,pn-1'15
Planning and Development Services
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Building and Code Regulation Division Commercial Residenfiat
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772)462-1578 03AI3031i
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: ,
Property Tax ID#: f ''601-02169^f7 Lot No. q
Site Plan Name: 1��; �5 Block No.
Project Name: T n tca&
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DETAILED DESCRIPTION OF WORK:
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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 _Pond
_Electric _Plumbing _Sprinklers _Generator _Roof _Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ ; ; Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name: nflav --
Address: Company:
City:C�Pir� State: Addresslam 40
Zip Code: — Fax: City: Stater
Phone No. 7 7�-y d D� '� Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License � -0
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: 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.
Signat re f Ow er/Lessee/Contractor as Agent for Owner Signature f Co tractor/License Holder
STATE OF FLORIDA , STATE OF FLORIDA
COUNTY OF ,7I y rlC COUNTY OF
Swor (or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presence or Online Notarization Physical Presence or Online Notarization
this 21/ day of lit" 202P by this day of 2020 by
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Name of person making statenient. Name of person making statement.
Personally Known OR Produced Identification`� Personally Known OR Produced Identification
Type of Identificatio Type of Identification
Produced r!,,, Produced
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(Signatur6 of Notary Public-Sta of Florida) m (Signature of Notary Public-State of Florida )
Commission No. (Seal) K o = Commission No. (Seal)
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REVIEWS FRONT ZONING W601 . PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW 11 M&cc REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE N
COMPLETED Q
Rev.