HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: Q
RECEIVED
NovCOUNTY ® 2 1010
Building Permit Application PerStttLugiDepartment
epa y nt
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: (A\r\
Address: a'1 f •
Property Tax ID #:
Site Plan Name: _
Project Name:
n
C_ ov v�Qlu
iff �
Fort 50601 (,t":e
CIM.y to 1, •oA!
New Electrical Meter Second Electrical Meter
Lot No.
Block No.
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. R. of First Floor: Ix 13 Lf X
Cost of Construction: $ �00 0 Utilities*§,SewerctJ Septic Building Height: JAP�
OWNER/L'ESSEE:
CONTRACTOR: �}
Name /41d .1 GttellAir
Name: 94tJL C3..e kIt
Address: Q4It( S Pei ema.% 9W)f
Company: S%boog LIw s G. ggf pM,t :4
City: Qaj Sa,Aot- Stater
Address: 177 N US Myle :. 24 4
Zip Code: S Fax:
City: Ti'Is►.ests r-L 33(NI—State
_
Phone No. 7 z � Y�G ' �o �'
Zip Code: 33 �! L Fax:
E-Mail:
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail SvA
from the Owner listed above)
State•or County License C B G I A 6 2.7 A S
_t :- -senn _- ___ - nrrnnnen -s r--s- .��...-�.�
U�PPL`EMENTAL�t�N�T U CAN Lill
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:64,4Jt.,i, I B0.%1e0y_ . _
Name:
Address: 417 Gvco,y,.A Avz -
`
Ad'dress:.
City; _ tt 1Ai%#t . � - State:
'City: State:
Zip: U,eI�Phone me> % - 20- R119
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 priorto 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 poolsefences, 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 b-e"recorded, in the public records of St.
Lucie County and posted on the jobsite.before the firstfris'pection. If you intend'to obtain•financi'ng, consult
with lender or an -attorney before commencing work or recording our Notice of Commencement.
-41
Signature, of Own r/ Lessee /C tractor a for owner Signature of Contractor/License Holder
St -ATE OF fLORIDA:-�,*r�) STATE OF 9 T��RS
;COUNTY JJF COUNTY OF 4]a.�1 UY,
rn to (or affirmed) and•subscribed before me of
�Physical_Presence or Online Notarization
2020 by
a•,of'person making statement.
Win,-=a,r.-.:,• :,,�; _ .
pally Known' OR Produced Identification
of Identificat on-_,.:_
(Signatur`.e of.NotaryJ
Commission No.
REVIEWS
of Florida
Sworn to,,(or affirmed) and subscribed before me of
• Physical Presence or Online Notarization
this chat y of ®t�he� 2020 .by
Name of person making statement.
Personally Known _"DR Produced Identification
Type of Id ntification
Produce
of Notary Publ
e JASON ELLIS
(Seal) ommission No. No(sejo)a131843629
.�� My Commission Expires
January 4, 2023
COUNTER I RE' W I S REVIIEWOR I REV EW I PNSVREV EWON I SEEV EWEGETATIATURTLE I � EVI WVE
DATE
DATE
COMPLETED