HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
�CEIVEp ^
Date: Permit Number: 1 n S
A G 1;1...;2021
.aMILMNt.Lucie County
_.
Permitting
Building Permit Application
Planning and Development Services
Building and Code Regulation Division COITii'iercial ReSidehtial
2300 Virginia Avenue,Fort Pierce FL 34982
'Phone: (772)462-1553 Fax:(772)'462-1578
PERMIT APPLICATION FOR: .. _
PROPOSED IMPROVEMENT LOCATION:
Address: 0 JC L�.o
�o t Property YTax ID#:
Lot'No. a
'
Site Plan Name: k4"L"`)azr - Block No. , C
Project Name: 2_'
DETAILED DESCRIPTION OF WORK:
W"ill -_0 ,�C)E( o i c �' ' � 1 t.
1 l{,c lL - cv 6o Ps i —� vz- �csnc r�
New Electrical Meter Second-Elearical Meter
CONSTRUCTION,INFORMATION:
Additional work to be performed under this permit—check all that apply:.
_Mechanical _Gas Tank_ `_Gas Piping Y'If _Shutters _Windows/Doors =Pond
_Electric - _'Plurritiing - _Spririkle�s :. _Generator Roof Pitch
Total Sq. Ft of Construction: Sq.Ft. of First Floor:
Cost of Construction:$ L` Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR: -
Name 2 .Name:
Address: Q_ _ l_tea„, cY �� Company: t� , �M�A G e►� S i
City: rp State: Address:
Zip Code: . �9 S 1 Fax: City: . �c�L�t' State:—Qj,9—
Phone No. . Zip Code: Fax:
E-Mail: Phdrie-No 2 7--`-557;7•?—u�-7 1 '
Fill in fee simple Title Holder on next page(if different' E-Mail CjL. s 1Mla,-L 1 q✓i1 r ,/rem
from the Owned listed above) ;State or County License_ OC��
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.
_.
SUPPLEMENTA(CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone _ Zip:::. 1 ' 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.
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 rooins 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., Notice of CoMmencement:must"be recorded in the public records of St.
Lucie County and posted on the jobsite'befd�e the"first-inspection. If you intend"to obtain financing,,consult
with lender or an attorney before commencing work or.recordin . o tice of Comme_nQenjeapt.
Signature of Owner/Lessee/Contractor as Agent for Owner Sig ture of - actor/Lie r
STATE OF FLORIDA STATE OF FLORIDA-.
COUNTY.OF COUNTY OF "''
Sworn to(or affirmed)and subscribed before me of l Swg#n to(or affirmed)and subscribed before me of
Physical Presence or Online Notarization - t, ✓•. P ysical Pres nce' r Online Notarization
this day of 2020 by this. .4gy.of 2020 by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of-Identification Type'of Identificabon
Produced Produced V
(Signature of Notary-Public-State of Florida) (Signature of Notary Public-State of Florida)
Commission No. (Seal) Commission No. "Cd''o KARENSIUQLSEN
Mate.of flori a-Notary Public
Commission # GG-207484
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My k..UTTTrnTS31
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June 12, 2 2Y
REVIEWS FRONT' " ZONING SUPERVISOR PLANS --VEGE VE
COUNTER- REVIEW REVIEW- REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE -
COMPLETED
ev.5/6/20