HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO, BE ACCEPTED a- U,�`
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Date:11- 9- al e . Permit Number: v1
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a Building Permit Application
Planning and Development Services PemNttfn9 Department
Lucie
Building and Code Regulation Division Commercial Residential V/St count,
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: 80l 19V-4 b8 KA
Property Tax ID #:
Site Plan Name: Block No.
Project Name:
Z3-1y: Cl new Geo 0kait y2 :2 KW i em4d r- 3 «o Amp- 7;ao54r 5Wi"c4n
keVeeA I�SrDe, �oya.�►tp-1�Srsf�w� 'enei �✓aKs - $w�� (wipe try,
r ki r+j "u %¢.erLw- Any �otdl ferderS Am* A00k &0-
New Electrical Meter Second Electrical Meter ®s
Additional work to be performed under this permit— check all that apply:
Mechanical _ Gas Tank ZGas Piping _ Shutters = Window§%Door's _ Pond.
-,�,Alectric _ Plumbing _ Sprinklers ✓Generator _ Roof Pitch
Total Sq. Ft of Construction`:Sq. Ft.-of.First Floor:
`SevJer _Septic Building Height:
Cost of Construction: $ � ` M/ Utilities: .=
Name: Sap%e
Name 10
fen
Address: gOi CVNI&mpbe l A10a
Company.,
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City: rt. Pl'ere6 State: FL
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Address ;,,
City: State:
Zip Code:Fax:
Phone No. 772. am - 8314.!j�
}Zip Code:" Fax:
E-Mail: �n r k & beVSaa h • ne '
`Phone No'
Fill in fee simple Title Holder on next page (if different
E-Mail
-State or County License
from the Owner listed above)
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:
_ 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;au f brize the permit holder to bbild the subject structure
which is in conflict with any applicable Home Owners Association rules; bylaws orand-d6vena" ' t.' "Tifay restrict or prohibit such
structure. Please consult with your Home Owners Association.. and review your,deed for any restrictions which may apply -
in g f t q p Y ge a
In consideration of the . ranting of this requested permit, I'do hereb' a ree that I will, in'al'I'res`pects ''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 Recorda'Notice of Commencement may result in paying twice for
improvements to your property. A NoticeofCommencement-must be recorded.inthe public records of St.
Lucie .,County phd poste.d,on thejobsite before the first inspection: If you Intend toaobtain financing,, consult
with lender or an attorne before commencin work or record:in our Notice of Commericetrient:
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Signature of Owner/ Lessee/Conic or as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Luc —re-
COUNTY OF
Swprrr t or affirmed) and subs r' d before me of
Sworn to (or affirmed) and subscribed before me of
�Ph .sical Presence or Online Notarization
_ Physical Presence or Online Notarization
this day of2024 by
this day of 2020 by
Name of person making statement.
Name of person making statement.
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Personally Known OR Produced Identifica '
v
Personally Known OR Produced Identification
Type of Identificdt�r�
,�as��
Type of Identification
Produced dJC�
I.S=
Produced
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(Signature of Notary Publi tate of Florida )'
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(Signature of Notary Public `Slate -of Florida')
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(Seal)
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Commission No.(Seal)
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