HomeMy WebLinkAboutPermit AppAll APPLICA LE I IFOf MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
S
Date: I 1) Permit Number:
°' 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: S
Address:
C
r>r•Sp
Property Tax ID #: 1301, b 0-Z' 0072 `040 Lot No.
Site Plan Name: t!s(C KV �''� Block No.
Project Name:
OF WORK:
L� 6,t1 VAN k- %`1 v r1 i
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION tNFORMATtON:
Additional work to be performed under this permit -check all that apply:
_Mechanical x Gas Tank xGas Piping _ Shutters Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
_ Generator _ Roof Pitch
Sq. Ft. of First Floor:
Cost of Construction: $ �--1 b6 `y0 Utilities: —Sewer —Septic Building Height:
OWNER%LESSEE:
Name n Iti&k $�`�
Address: I 60Jr(L181r_AV_5 oA,64
City: 'PC e me e State.P
Zip Code: �'f�t�� Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name: t S e.i:, i C %.,u . jeu ),
Company:
Address:,$�i
City: %:,:; State: Fri
Zip Code: �� (� / Fax:��� ?6�6
Phone No
E-Mail A—) l22()'CkYfnl �_ AY-iTZ
State or County License L 7
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.
ry i.-
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 our Notice of Commencement.
i
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nature of Owner/ Lessee/Contractor as Agent for Owner
STATEFLORIDA ��• % . ,C
COUNTY OF
Physical
Swor o (or aff' ed) and subscribed bef re me of Presence or Online Notarization
�
this day 2Q�� by
17 V 1. -A .b n
Name of person maifing statement.
t�PYo6B� AUDREY B. HUMPHREY
Personally Known ed Ide tification * "*; MY COMMISSION #GG300817
Type ofldentificationProduced `
EXPIRES: March6,2023
j-n
Bonded Thru Notary Public Underwiters
AiAl V
(Signatu of Notary P ic- State of Florida )
Commission No. (Seal)
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Rev 20 21