HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date Permit Number:
P e C a L' :z —'- Building Permit Application
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:
PROPOSED IMPROVEMENT LOCATION:
Address: .S:Go"? Myr+la Dr
Property Tax ID li - Q69 7 - DO d
Lot No. 9
Site Plan Name:
Block No. -s y
Project Name:
DETAILED DESCRIPTION OF WORK:
`Tam oLF r xf<� in rood aAc1 inSi all n� sv rv,c�nl
1Zoai
and t-)I!%an=r 4rn!,i_
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 �[ZPitch
Total Sq. Ft of Construction: / 7/5' Sq. Ft. of First Floor:
Cost of Construction: $ Q) Sdr) Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name G L7r. L GC
Name: %tr64SUiL
Address:_i�aN /7f:1 AUt.
Company: YiQn mqilmp
City: L'� r o a ly u State;
Address: l !a 6w 1I't �k w. i
S+.
Zip Code: Fax:
City:'Rojc t�. i o%4
State:4:
Phone No,
Zip Code: 3y q �iic( Fax:
E-Mail:
Phone No 714.310 -cii
Fill in fee simple Title Holder an next page I If different
E-Mail C 12oo'G iwl Lc.G� Qli
from the Owner listed above)
State or County License 11 123446
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.
4
45✓
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: Applicable
_Not
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
i
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 of 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 attorne�efore commencIn work or recording our Notice of Commencement.
✓-f32 �a
Signature of Owne L ee/Co ntractor as ent for 0 i Signature ofyrkl_9ire eHolder
STATE OF FLORIDA < STATE OF FLORIDA
COUNTY OF Jt , t/ COUNTY OF (/G .•�
Sworn to (or affirmed) and subscribed befc, Sworn to (or atfirmed) and subscribed before n610
-4 Physical Presence or Online Not i t APhysical Presence or Online Noteiz i :<
this day of �, 2020 y this day of ✓I , 2020 %T�• ` '
6
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Name of person making statement. I Name of person making statement,
Personally Known 2V— OR Produced Ide fiaat�rr� o ! Personally Known � OR Produced Iden i i
Type of identification V Type of Identification
Produce II Produced w
J�
ej x om
(Signature of Notary Public- State of Florid . (Signature of Notary Public- State of Florida j
Commission No. S6 cocldgd (Seal) Commission No. CT6td7< (Sea1)
REVIEWS FRONT ZONING j SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE --
RECEIVED
DATE
COMPLETED