HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
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:
a vDri
Address:
Property Tax ID #:
WON uoilolin
Lot NoZ& � �i?)
Site Plan Name: Block No. 23
Project Name: P70U/0 r(-�-Q
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit - check all that apply:
./Mtiechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
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Cost of Construction: $ S 1 9-7_
Name-L
Address:
Generator Roof Pitch
Sq. Ft. of First Floor: _
Utilities: —Sewer —Septic
City: k:7j--- r(`eCC!P State: %'L/
Zip Code: Fax:-77? ^398 'Q-2Z'?
Phone No.'1'72��9��q�2S ?
E-Mail:_Gyy()S�yi(,(fliiLl
Fill in fee "simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Compan
Building Height:
1
Address: 16-2,o S &Q Nlowmev Ci]J't?
City: State: P7,
Zip Code _ rJ Fax�?7?--'S9 oC/7y'?
Phone No �7-7?, *3
E-Mai 9 laIIP1 c,4f�
State o Count
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.
DESIGNER/ENGINEER:
F,.
_ Not Applicable{
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
— Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
Vw1V[K/ WN 1 KAL I UK AFFIDVI I 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 commencing work or recording vour Notice of Commencement.
Si,Jif Ow*rJ Lessee/Contractor as Agent for Owner
n Cont a or/License Holder
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STATE OF FLORID► t.
STATE OF FLORIDA
COUNTY OF 5'J f e
"
COUNTY OF I (.t.� C['e
SwVn to (or affirmed) and subscribed before me of
Swor o (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 12020 by
V. Gm6rnountl
, 6rm rn
Name of person m king statement.
Name of person n4kini statement.
Personally Known OR Produced Identification
Personally Known ylo� OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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C' C1.
(Signature of Notary Publi
(Signature of Notary Publi
�.►�' Notary Public State of Flom
�� Notary Public State of Fonda
Commission No.°smG
t/10/2 24 983089
Eswres05/1012024
Craig,@ossman
ommission No. j My C_emmi stop GG 983089
•andF Expues05it0/2024
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