HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: OO 170 ZoZ I Permit Number:
S�Lea
IQ4#W 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: r �,
PROPOSED IMPROVEMENT LOCATION:
Address: 02Z " Limmysn Y- 7
Property Tax ID#:t�3577
, 5 -�� - 0 1 q� - 0� - � Lot No. � Jq
Site Plan Name:
� A`v\C��r LI \� lt✓k�1�� Block No.
Project Name: " r�Aj�)��
DETAILED DESCRIPTION OF WORK:
3 ) C 1?(',�r tDW-P \S
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 ZC Shutters _Windows/Doors Pond
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ J1 9qq Utilities: —Sewer _Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name Vr \ e Name: Ui
G
Addre s: �U�(Y C\��/y,�(1 � �� Company:
City:' no1C-A- (_U k e State: FJ- Address:
Zip Code: 3 �"� -I 8(Q Fax:
City: r;�rk (s(I 1 u i� State: FL-
Phone No. CIN - 8 Z q - (0 `t 3-I 11 Zip Code: 9 Fax:
E-Mail:_ Y-JUMP.- YDQ-cW ►�-l �()th—n� Phone No 11 Z - 20I - qq l q
Fill in fee simple Title Holder on next page(if different E-Mail , US'r flnUVktr it e Q I(1')( coyy)
from the Owner listed above) State or County License ram' ,4 `dog,_
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:
DESIGNER/ENGINEER: 1\ 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 lendl or an attor before commencing work or recording our Notice of Commencement.
Signa ure of Owner/Lessee/Contra c r a Agent for Owner Signature of Contractor/License Hol er
STATE OF FLOP4PA STATE OF FLORIDA
COUNTY OF C lam, COUNTY OF
Srn to(or affirmed)and subscribed before me of Swgrq to(or affirmed)and subscribed before me of
Physical Presence or Online Notarization _,Physical Presence or Online Notarization
this day of 12020 by this day of 2020 by
Name of person ma Jng statement. Name of person making statement.
1 y
Perso y Known OR Produced Identification Personally Kodig -,. OR Produced Identification
Typ of Identification ' Type of Ide,tification,,.
Pr uced Produced''
17/—�)(
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(Signature of Notary Public-State o�Florida) (Signature of Notary Public-State rida commission#�GG 295930
':p „Q&e ALYSSA A.T.BOWSER Expires January 2fl,2023
sir mission�#GG M930 � o Y
Commission NoI�`*� f' �(Se�a4�' " Commission NoG� � FOFf 0��(5e9�)Chu6udgetNoarySerai as
a V 0, Expires January 28,2023
9�F0F F�P\ Bonded Thru Budget Notary Services
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20