HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: log'0
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: (7721462-1578
PERMIT APPLICATION FOR: D (�10�11 LS
Address: �
L�1�( l�L
PropertyTax ID #: f 4414 (I0 - .2 Lot No,
Site Plan Name: Block No.
Project Name:
3 STD Y1-m RhyieL WeXj j o t
New Electrical Meter Second, ElectricaI Meter
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Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _V<hutters _ Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers _Generator. _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ �� S4 �� 000 Utilities: _ Sewer _ Septic Building Height:,
y a gi
QWNER LESSEEtx
Name
c
CONTRAeTOR�z� a, y
Name:Steve Mears
Company: Lifetime Exteriors
Address,:- It (�l��il\1 ( L� �`f�
City: tTl. i i-k N.5 od I S(, Q Stater
Zi p Code: 5 LtQ Fax:
Phone No.
Address:102 South F St
City: Lake Worth State: FI
Zip Code: 33460 Fax: 561-582-7505
Phone No561-533-8700
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-MailKrystal@Lifetimeexteriors.net
State or County License CGC1 529442
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.
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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 inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording your Notice of Commencement.
S nature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/Li nse Holder
STATE OF FLO DA
STATE OF FLORIDA
COUNTY OF JACM
COUNTY OF PkiV Q0gal
Sworn to (or affirmed) and subscribed before me of
S orn to (or affirmed) and subscribed before me of
Physical Prese�nnce or Online Notarization
Physical Presggnce or Online Notarization,
this day of VULu 2020 by
this :L day of 2020 by
Name of person -making statement.
Name of person making statement.
Perso ly Know O Prod ed Identification,X,
Perso y kn n Pro uced Identification
Typ of Identifi do
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