HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fart Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address:
G _hD
Property Tax ID #:� �" I ( -Q " v ^O Lot No.
Site Plan Name: e ++ Block No.
Project Name: �' 1
DETAILED DESCRIPTION OF WORK:
C
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: 1 r Sq. Ft. of First Floor: _
Cost of Construction: $ CA , 2-4 0 Utilities: —Sewer —Septic
Building Height:
OWNERf LESSEE:
CONTRACTOR:
r
Name
11(2
Name: J6h1 r
Company: Por
t
Address:r I r
City: , )
Zip Code: Fax:
Phone No. �y1� _ ((� 2���
State: FZ_
Address: [141 2 (A)
_�D�
City: Vim- State: -if
Zip Code: �"1 (0 Fax:
Phone No 1 � -113 � (l0 o�oh tt�-C-61-)2�s
E-Mail:
I 1 `�) C -d�-Gt � e I I Gi G►iYY- I) LC
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail /4iV' , AVf6;D_
State or County License
If value of construction is 2500 or more, a KELUKUtU Notice OT Lommencemem 1s rcquucu.
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 TITLEHOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name:_
Address
City:_
Zip: —
Phone:
Name:_
Address:
City:_
Zip:
Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to ao the worK anu tIMWIauvii 0� uIUI .GL u.
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
•.. t_ 1 _ _ J__ _ . L....F--0---J--vl•lll•le nn in Q Uir%A, r%r rcrnrr{inv vni WNntice of Cor mWincement.
Wiirl I@nUCf arr aLwiIM
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Signature of wn r/ Lessee/Contractor as Agent for Owner
Signature o ontractor/License Holder
STATE FLORIDA
i� %��Ct `e�'
STATE F FLORIDA4�
COUNTY OF
COUNTY OF t�
Sw�to (or affirmed) and subscribed before me of
Swor o (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Presenc or Online Notarization
1,
this -9/ day of 2020 by
this -7,1 day of 1 2020 by
Name of person making statement.
ent.
Name of person maki:70R
Personally Known ✓OR Produced Identification
Personally Known Produced Identification
T -e of entification
Type of Identification
roduc
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Pr c
(Sig at :Iry 11, 1 Llu(SigLuron
of ►� rida
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= -MY COMMISSION # GG 17 "51a)
Commi ES: MGmber25, �
_ =tPRY Pcr:: GWENDOLYN
Com N _* `_ MISSION QM551
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Bonded rnru Notary Public Uwlerwri m
='rF Pam' SPIRES: December 25, 2021
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DATE
VED
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LETED
Rev. 5/6/20