HomeMy WebLinkAboutBuilding Permit Application - Emerson Ave All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
91r. PIECE
b I Iola
Cr�l -9220
)i 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:
Address: (9'S 19) 4C-J-(�r50-)
OL
Property Tax lD#: 0 Lot No.0
Site Plan Name: Block No.
Project Name-" 1.1-haeL, bXrOLA
D,�D�S�CRIPTION OF WORK-----------
!7�
r-00[�. fl'�Akj RiS CYAOW I I rAMdr 0
4-4
&c�- L-7t-
New Electrical Meter Second Electrical Meter-
CONSTRI�'CT�ON 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 Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 0 0 Utilities: —Sewer _Septic Building Height:
) '
CONTRACTOR
Name &J",01A Name:
Address:W711Fry-Wr;,vo -1 f-\I"— Company: ar %a �n
City:fc%F �J-ercg. State�F�- Adc1r-ess:e(-Q1 Lot hJA&r 'D19tVL()-
Zip Code: 340t As I Fax: city:, k/61 Ar IA'w" State-T-L'
Phone No.�-Z>ia> -�3?-p-D Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License :�5� 17,V
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.
Sl7PPL�M�E�NTA�C�ONS�TRU`CTI�DN�LI`E�NzLia►�U1l�INF�tOR�MAT�I ��N �����
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,1 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 in to obtain financing, consult
with lender or an attorne before commencingwork or recordingour ' e f Commencement.
Signature of,Own
e see/ o Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF cyC�C-
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Pres nce or Online Notarization hysical Presence or Online Notarization
this day of �, 202� by this-,day of 2020 by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Kn w OR Produced Identification
Type of Iden ifi n Type of Identi c i¢n L LQtf,
Produced Produced l/
-Hamm t
(Signature of Notary PublicM_ 'rAi@WHH087667
V Public (Signature of tary P dfl6tslycPd�l)IpC
State of Florida State of FlofW
Commission No. d Commission No. GommB(8 Expires 2/1/2025 Expires 2/1/
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.