HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1\ �(
Date: Permit Number: I��'' 6q
91ro �,_... _ JUL 1021
` FT. °' ° Building Permit Application �QrSttV-uin
ce nment
Planning and Development Services t
Building and Code Regulation Division Commercial Residential 1�
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSEWMPROVEIVIENT LOCATION:
Address: lq® > - &' C
Property Tax ID #:
Site Plan Name:
Project Name:
DETAILED b_ESCRFPTION -OF ;WORK:
New Electrical Meter Second Electrical Meter
-CONSTRUCTION. INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _• Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
_ Generator
AWindows/Doors
Roof
Sq. Ft. of First Floor:
Lot No.
Block No.
_ Pond
Utilities: —Sewer —Septic Building Height:
Pitch
OWNS LES5EE:`
CONTRACTOR:' `
Name Xp ..5
Name: /C /-Y'-
Address:Zggia 14 Tf S rZ457_
Company ,e4l��r7A16
eli-d
City: ^-le Ate! State:
Address:
Zip Code l"VJ— Fax:
City: 4 sl7 A State: L
Phone No.
Zip Code:349!10Fax:
E-Mail:
Phone Now� l i-QO""c�Jc-/9
Fill in fee simple Title Holder on next page ( if different
E-Mail/L.�C �f��'� � G dml
from the Owner listed above)
State or County License %�� � 78
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.
`�,�
C t� � 1 � a
+� Sl r*f'"a '�"cz
t `'< ""r '�+° ;;'� z%�:: �.'' `5a,��
�"'�,k •,� -y,Y.� z?, k.,� r
.F°�i�{s
u -.s:., ....- .....:. _a. ..,,. .s.. .. :. u4
tui ;a:'c' €a�v �' �.� �-a4� ' F s->b••Y� r,� �� �.
.. ,rr,�,.r ru•x. ._...cu_., t�.+'�*�J+.s�
..i 3�&�t'...rk� �,.. �r�n�; �.<... s.�rr?;,?r�
,�.>�'S.'�.a.'ia 3 .;nrsz �j° .�.�'"tar, .�... te.�+kt'.�. t
,.. .�u +, .. .,..
?�� - .m ka_ b K a .fir. ;r.',
.. �
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 concurrericy 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
,4-1. ,., k -F-moo „.>• rrun.,Anrr %Ainrle nr rornrdina vniit Nntirp of Commencement.
wiui i1="UU1 %A Cl" auL"a:-
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of C ractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Presence or Online Notarization
this day of . 2020 by
this day 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 Identification
Produced
Produced
(Signature of Notary Public- State of Florida)
(ignature of Notary Public- State of )Hannah Do Ru yssclw
NOTARY PUBLIC
Commission No. (Seal)
Commission No. I*TE OF FLORIDA
Comrr> GG24199&
e�
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev. 5/ b/ LU