HomeMy WebLinkAboutBuilding Permit Applicationz`
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACC PTED
Date: Permit Number:
oac�c�Dr�
0
°�Tual 0 [mD+ Q Permit Application
Building Pe p
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: Shec(
PROPOSED IMPROVEMENT LOCATION:
Address: t S ^1
Property Tax ID #: 3 '1p 03 '-5D r M
Site Plan Name: mid
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter.
CONSTRUCTION INFORMATION:
Lot No.__
Block No. _—
Additional work to be performed under this permits check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric — Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: ADO Sq. Ft. of First Floor:
Cost of Construction: $ Utilities:wer —Septic Building Height:
OWNER/LESSEE: _ CONTRACTOR:
Name 1
Address:
City: P State
Zip Code:.` (aFax:
Phone No. _ h a''
E-Mail e• ap
Fill in fee simple Title Holder on next page ( If differ,64
from the Owner listed above)
Name:
Company: U She
Address: g E.
V City: State:
Zip Code: 3a&1-7 Fax:
Phone No -4 O` a - &4
E-Mail rnQ_a (-re c. QM •cow\,
State or County License ac s
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�E GINE R:' _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name: W 1
Name:
Address:
Address:
City: Sta a
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.
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 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 attnrnpv hpfnrp rnmmpnrina wnrk, nr rprnrrlinp vour Notice of Commencement.
&Contr�actolHolder
Signs r f ner/ Le ee/Contractor as Agent for Owner
Signature of
STATE OF FLORIDA
COUN�TYF V�
STATE OF FLORIIq
COUNTY OF V
Swo affirmed) and subscribe before me of
(or affirmed) and subscribed before me of
Swo/r.
Physical Presen a or Online Notarization
ysical Presencer Online Notarization
this � day of 2020 by
this 4 day of 2020 by
Tom Sau,rw
Name of person making state t.
Name of person making state ent.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
AL A -10( my�
(S g ture of Nota ublic- State of Florida)
(Signature of Notary ub Ic- Sta a of Florida )
Commission No. Se
taryPublicStetradF
Isslon No. ;�y�j / td��n', Panne W, he m
.l�t'��y
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Ashley Anne Wilhelm
MY Commissloti GG 359334
Expires 0712512_0_2
4 Ex
Tres 07/251202J
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