HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
1`Ai L U
41 40 14, 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:
PROPOSED IMPROVEMENT LOCATION:
Address:':: J
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:'1kos��k yyorvl
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.............DETAILED DESCRIPTION OF WORK: ISS
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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 Shutters 45-�Windows/Doors Pond
Electric —Plumbing Sprinklers —Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 0 c)9 5 uc) Utilities: —Sewer _Septic Building Height:
Eg paw, WSRMM,
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OR
Name N)-O5Vv-q Name:
Address: 664,1 1 Company:-S
City: J?14�,CL-R- Stater Address: ez�- -b ►-X� _,,e,lL C_7+
Zi p Code: -2- Fax:— City: State:
Phone No--I-),?- - CA�L%-\ I L-V�k Zip Code: --�SL,46tX U Fax:
E-Mail: Phone N o-l-')-Z-, '>�S
Fill in fee simple Title Holder on next page if different E-Mail
from the Owner listed above) State oYCJnty Li se ZIA
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.
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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 ONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/ CONTRAC AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that now 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 attorney before commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner se�. e,
STATE OF FLORPA STATE OF FLORI
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COUNTY OF -_-,�Y-t V_,_4G e. COUNTY OF I�-
rn to(or affirmed)and subscribed before me of n to(or affirmed)and subscribed before me of
Physical Presence or Online Notarization to
Presence or Online Notarization
this day of ,2020 by this day of 2020 by
_fir, �i G ��
__JL:V� - — .
Name of person making statement. Name of person making statement.
rsonall K < Personall Kn
Type of Identification iP *�l'c„ Notary Public state of Florida Type of Identification o.J"•w. Notary Public State of Florida
Ashley Del Toro Produced 1S Ashley Del Toro
Produced ssion HH 052369 s ' ,P• Y omm"Mri HH 052369
o•R ExPitEs 10/11/2024 �iawd� Expues 10/11/2024
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(Signature of Notary Public-State of Florida ) (Signature of Notary'Public-State of Florida )
Commission No. (Seal) Commission No. (Seal)
i
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5