HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
ssro
L 19 O
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X� \A
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:��_,�
PROPOSED IMPROVEMENT LOCATION:
Address: S� a3 l _Q1rnouS.-H(` PL
Property Tax ID #: 3!j a-1 �jC�� OQ�, a 00(2) n Lot Now 1 O 1
Site Plan Name: _?-2)Tn 2 0,\f Block II`il""oVo 1 l
Project Name: '(irPnba K1cCkLl\e-
DETAILED DESCRIPTION OF WORK:
Pe 9 a Cord i no ShutterS
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: $ _ ` o() L4S Utilities: _ Sewer _ Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name i \�-
Name: SV
Address:l a-� Gn r+nc�USt► C oL
Company: S I� tTye r I �-
City: _(fit S-} (_1K�.1P State'T-1nn,,
Zip Code: UFax:
Phone No. ^1 CU 51
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Address: r'&e_' Y
City'fi-E State:�k
Zip Code: J� �(� Fax:
Phone No �1 1
E-Mail' t' Ir
State or County License �G\
n Vd1UC of consLrucuon is LSUU or more, a KtcUKUtU 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 inspecti n. If you intend to obtain financing, consult
with lend r or an attorneybefore commencingwork or recordi our Notice of Commencement.
f
ature of Owner/ Less e/Con actor as Agent for Owner
Signature of Contract r/Lice se Holder
STATE OF FLORI
STATE OF FLOR
COUNTY OF_ :t x A
COUNTY OF uc
Sworn to (or affirmed) and subscribed before me of
sical Presence or Online Notarization
this I day of � �%Y" 2020 by
Swo to (or affirmed) and subscribed before me of
hysical Presence or Online Notarization
this 01 day
of 20211 by
`rvr P I C�12 01,w1�1
1l '-
Name of person making statement.
Name of person making statement.
Personally Kn OR Produced Identification
Personally Known_ OR Produced Identification
Type of ntificatio
Type of enti i tion
Prod u d
Produ ed
(Signs otary Public- State of Florida)
(Signature o Notary Public- State of Florida )
q90ALY5SA A.T. BOWSE
Commission No deal)
Ct "`"`r.P°O'�, ALYSSA A.T, BOWSER
Commission No. ' T C�9)on#GG295930
t Commission # GG 29593�;
Expires January 28, 202c,;:Bod�,ouVatervser
Expires January 28, 2023
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