HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICAB INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: f� ZD2 Permit Number:
LLUQtLE
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,
oZI
Property Tax ID #: ,2- L570 a- O,Z /3- OO 4 Lot No.
Site Plan Name: Block No.
ProjectName: i N� .r ✓}
New Electrical Meter Second Electrical Meter
Additional work to be performed
—Mechanical Gas Tan
under this permit - check all that apply:
k — Gas Piping �XShu�tters Windows/Doors Pond
_, Electric — Plumbing — Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
,,,,_ Generator — Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
ry YY.
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Name C . rrrt
Name: -7- o -C
Address/6 C� dJ- YR�L O
Company; COAti «
r:
City: '0 v State:
,,,1 .,
Address:- -; 3 d L,,'r
Zip Code: 0V9sA Fax: 3VS-2 _
City: rer Stater
Phone No. 772-
Zip Code: _ay 9 y, _ Fax: -77?_- W I-Afrr
E-Mail:
Phone No
Fill in fee simple Title Holder on next page ( If different
E-Mail o , G cc' v4w,
from the Owner listed above)
state or County License
If va L n of r...d•re..+:....:� Tenn __
--• _ •--..�-..+* �'.+.. No ,G.,w v1 111ul c, a nck unutu IVOLICe OT C.ommencement !s required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:-
4 Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:_
Address:
City:_,____
Zip:
Phone:
4Not Applicable
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 lender or an attornev before commencine work or recordine vour Notice of CommenremPnt-
Signs ure of O essee/Contractor as Agent for Owner
5i ature of Contra or/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
%
COUNTY OF s
COUNTY OF G,y
Swor (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
7rPhysical Presence or Online Notarization
this � day of . s 2020 by
el Physical Prese ce or . Online Notarization
this W dday of 5T - 2OZ6 by
Name of person makin statement.
Name of person making statement.
Personally Knu+n ; �. R Prodr�9ARelsbtatiftcation
Personally Known :=:YPft Produ�jf�tion
Type of Identicati ':s -'�= Notary Public State of Florida
Commission li GG 237991
t`
T e of Identificatio Notary Pubtic •State of Florida
yp 'Fs_ Commission
Produced orc�A_
Produced ? o: # GG 23T991
Expires Jul 12, 2022
y omm. xprres Jul 12, 2022
( 'gnature of Notary Public- State of Florida }
(Signature of Notary Public- State of Florida }
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Rev. 516170