HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
a Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential AV-
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: rCA C-i 0 V- a (S1f1 "F(EF--
Property Tax ID #: 3__�)a \ 1?k)15 0(__� ` (n-- oc) Q - k Lot No.
Site Plan Name: �- 1 `-- �-o'n � -
Project Name:
Block No. a
I DETAILED DESCRIPTION OF WORK: I
04E '� 1 `
New Electrical Meter Second Electrical Meter
I CONSTRUCTION INFORMATION: I
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping Shutters
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: Cost of Construction: $ \ \ '_A-Q
`a
_ Generator
_ Windows/Doors — Pond
Sq. Ft. of First Floor:
Roof Pitch
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE;
CONTRACTOR:
Naey2 lC
Name: SC�YVI�eI
�UZG.
Ad ress O 0.rS h T�(1-
City: CN''r" l.Ve i e_ State:
Zip Code'3(4Q�S Fax:
Phone No(C� CQ_t
E-Mail:
Company: J ost- Sh Uri- e�' 1+-
Address: S 1
Cityr_?C;;� St \" VC f_ State
Zip Code:�J 't�Sla Fax:
Phone No `Z�2a o \ Q,(:k k
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail vk- @Q
State or County License � a\q
n VdMt! or construction Is LSUU or more, a Hi:WKDtU Notice of commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAWINFORMATION:
DESIGNER/ENGINEER: Not Applica
Name:_
Address:
City: —
Zip:
Phone
State:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: ("Not Applicable
Name:
Address:
City:
Zip: Phone:
UVVIMM/ LUN I KAL I UK 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, 1 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 your Notice of Commencement
Signature of Owner,
ractor as Agent for Owner
STATE OF FLORID %/
COUNTY OFF C_J,
Swo to (or affirmed) and subscribed before me of
ghysical Presence or Online Notarization
t i�� day of 12020 by
y.�hnvQ � 7 ? C_
Name of person making statement
Personally Known ^— OR Produced Identification
Type pK&enti is 6n
P roAiucecl
(Signature of Notary Public- State of Florida )
s•r PI'S ALYSSA A.T. BOWS(
Commission No. ;gal) Commission GG 295
a4�a Expires January 28, 2i
oT Bonded Thru Budget Notary Se
Signature of Contractor/License H
STATE OF FLORIDQ
COUNTY OF Uc J' C_
Sworn to (or affirmed) and subscribed before me of
�ysical Presence or Online Notarization
t is day of 2020 by
Name of person making statement.
Personally Knowtalll� OR Produced Identification
Type of nti t tion
Proddced
R (Signature of Nbtefy Public- State of Florida )
*� s«u �a c A>I.T. BOWSER
mission N�� Ce t n # GG 295930
a ia,
. Expires January 28, 2023
r r .
a ary ervicoe
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