HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: 10 ja2 a— I Permit Number:
STa LUCIE
CO U N-T'Y
F L O R I D A
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATIO
Address
Building Permit Application /
Residential ✓
Property IaxIDN:
Site Plan Name: C:.6.rk.+' QO
Project Name: � f Lt1�r_� 25_ Apr
Lot No.
Black No.
DETAILED DESCRIPTION OF WORK: 1
New Electrical Meter,�.Second Electrical
CONSTRUCTION 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 6/!2 Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: 3.111
Cost of Construction: $ Utilities: _ Sewer / Septic Building Height: t/�w
OWNER/LESSEE:
CONTRACTOR:
NameVtj�.{[I Chhay
Name: arjk ffi Mfa0'o
Address: 114 QaS U lOYe. Cdd
_,I'f
Company:i� 1ice
Address:'7y/ �5 U/ P.5L
�i Vdl
City: ,t State:
ZipCode: Fax: rlr//t
Phone No,
City:State:�L
Zip Code: Fax:
Phone No 7771— 339
E-Mail:
E-Mail p_51T Pf/-101 e ]ct!
Gcym
Fill in fee simple Title Holder on next page if different
from the Owner listed above)
State or County License P j
/ 2.L7C9
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNF,):t/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: a 1IW r 7 n/C.
Name:
Address: JW9
5WP;)_ ir,�� Si
Address:
City: State:
Zip: Phone:
City: 5/ Stater,_
Zip: 4 Phone 77i—I —f�y!!
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 Countyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
yourHlome Owners Association lon and rev w your deed or for any restricovenants ct ons at whichtrict may alprohibit such
structure, Please consult witapplicable
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 poste on the jo ite before the first inspection. If you intend to obtaI financing, consult
with lender or a tt e bef co encin work or recordin o N 'ce of Co
Signature o wner/ Lessee ontractor as Agent for Owner Sig:;of Contractor/License Holder
STATE F FLORIDA STATE OF FLORIDA
COUNTY OF s% l i iCl Y COUNTY OF, 4 5�r BUG t
Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
X Physical Presence or Online Notarization x Physical Presence or. Online Notarization
this4-Ldayof lTLhe 202Q by thisL_dayof Lj-1 2020 by
(h.wY, mew-1 _M,Avi kPIA nnl7°
Name of person making statement. Name of person making sta
,lgysr Nolery Public
,,,jjj�y���I��Q111
n to or Florida
Personal) Known OR Pr nff22 66�7 ("BB ally Known �_ Veoft9rlt6 1p�i
pyppp- d" yCommission23 298212
Y X Q��pg1,yNic State of Fl ]Prod
Type of Identification d My Commission GG299fldentification aw Expirea0y0gnp23
Produced.,,, d� Expires 02r0412023 eed
1 1� p 1 y1
V� iollool Iv U Y] ��
(Signat6rb of Notary Public- State of Florida) (Signaturb of Notary Public- State of Florida )
Commission No. C;G A ib 11 ill (Seal) Commission No.l d98l (Seal)
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