HomeMy WebLinkAboutORIGINAL OWNER BUILDER PERMIT, Building Permit ApplicationAll APPLICABE INIF9 MUS.T BE, COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit, Number: ber:Al.
�rllr. E UKEES
Building Permit Appi.ication
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
Commercial Residential
Ji E P, 91 4, L
Property Tax ID #: coo j Lot No._
Site Plan Name: Block No
Project Name:
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 Pond
e 'ct r i C Plumbing Sprinklers Generator Roof Pitch';
Total Sq. Ft of Construction: Sq. Ft. of First floor:
Cost of Construction: $ A? X Utilities: Sewer Septic Building Height:
Name D4QE__
Address: �[ 5 BEACH \)Xn-
City: P, State:. 71
Zip Code: Fax:
Phone No. 15LIO
E-Mail: J_)J0DAe_:;:5 L-17 Roc-,
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
7
Name:
eis
1'v 1. State,
2�
'"`
Zip Code:
Phone No
E-Mail
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.
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:.
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING. COMPANY: Not Applicable
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 .obsite before the first insipection. Ifou intend to obtain financing, consult
with- lender or an attorney before commencing work or recording Vour Notice of Commencement.
4Sn�ature
of Owner/ Lessee/Cont ctor as Agent For Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OFj„ar�:' o
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
llotarization
_ Physical'Presence or Online Notarization
20 by
ILha
this day of 2020 by
Name of person making statement4
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
P duced
Produced
gna ure of Notary Publi tate of Florida)
(Signature of Notary Public- State of Florida j
Commission No. ��
Commission No. (Seal)
„
1m
it' ei M "20,�
OV 'w
REVIEWS
F
PERVISOR
PLANS
VEGETATION
SEA' TURTLE'
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
-. REVIEW
REVIEW
REVIEW
DATE
RECEIVED .
DATE
COMPLETED
Kev. 5/ b/ ZU