HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Y'n-94 Permit Number:
I-
1� Y. WCIURI
90
Building' Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
IT
. ...... . ............. . .. .... ...
rlr]rA-,-,- 511� 51 hleoro,+k u-i'ye- r-61,r &-ce_ FZ ?Vf F2
Residential X
Property Tax lD#: 34io�k 6n�7 (OLDS coo 12PLO, Lot No. 5 4
Site Plan Name: '�_11W0Pk 16170- Block No.
Project Name: 01piceba
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit— check all that apply:
—Mechanical — Gas Tank — Gas Piping Shutters Windows/Doors
— Electric — Plumbing -T Z Z> — N Sprinklers — Generator Roof
�,
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ A 97 gob Utilities: —Sewer — Septic
Building Height:
Pond
Pitch
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Name j16HA) Ctb&(
Name: CA(bt(-AA Q"r-t
Address: racllq 51krfonk-14
Company: T_
Address: & I ZG3
City: Fff-� ffefag- ft State:
Zip Code: 3Y9f2_ Fax:
PhoneNo.-7-72--
City: Tbkoo State:)L)C-
( - (0qro
Zip Code: �"ol'7 Fax: 3.7
Phone No 114e — 3,(9-7 — GPW
E-Mail:
Fill in fee simple Title Holder on next page if different
from the Owner listed above)
E-Mail A (0 1 ('vV-1 Cff4L�rh - 66A'
State or County License
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.
SURPLEMEN£TAL CQNSTRUCTIQN L{,EN LAW 1NQR11tIAT(U
3 S L r
DESIGNER ENGINEER: _ Not Applicable
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Name: O1(AA -y4"
MORTGAGE COMPANY: of Applicable
Name:
Address: 0 00Y 170
Address:
City: State: AX
Zip: Phone — (0`1— &'Ob
City: State:
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
,kvith lender or an attorney before commencing work or recording our Notice of Commencement.
Signature Owner/ Le ee/Contractor as Agent for 0 ner
Signature of Contractor/License Holder
STATE FLORIDA
STATE OF FLORIDA
TY OF pp 9
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
QLS-Physical Pr Bence or Online Notarization
this day of 202¢ by
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of 2020 by
Name Iperson making sta ment.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Prod%ed
Produced
(Signs re of Notary Public- Stilte of Florida)
(Signature of Notary Public- State of Florida )
Commission No. .�'�lhu�'"� 002=0
e E*MD600"2D._20n
Commission No. (Seal)
REVIEWS
FR
UPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 20