HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONt
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO.BE ACCEPTED
Date: Permit Number: cQO ` .bgg6
9M ILUEQE
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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:
Property Tax ID #: Ig-2 i{ Lot No.
Site Plan Name: � no jy�—� ��T 1�► no /�S I 41(7 Gr Block No.
ProjectName: 14 �Q Fes/ 44 0�S)��-f
New Electrical Meter Second Electrical'Meter
Additional work to be performed under this permit -check all that apply:
t
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric Plumbing, _ Spri4le'rs' _ Generator _ Roof Pitch
Total Sq. Ft'of,Const�r'action: _(�(hT( Y��3 �-'-� yr Sq. Ft. of First Floor:
:
Cost of Construction: $, S—�D'D, Utilities; _Sewer _ Septic Building Height:
Name 0 5 ^ `
[LDS
Name:�T9Gi.✓1 deO1`Re
Address: D s. �` ae
Company:(sCa2 e—
City: Pi e/-C,_ ;z, Stater
Zip Code: 3L/9'4(d Fax:
Address:
City: State: C�
Phone No.
Zip Code: .74:17— Fax:
E-Mail:
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: , 69ey,
D
Address:
City: o_r- )ut4d0
State:
City: State:
Zip: d3 Phone ,-2 O
// -d-7—
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 lender or an attorney before commencing work or recording your Notice of Commencement. .
Signature of Owner/ Lessee/Contractor as Agent for Owner
Sign u of Con ctor icense Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF=i4.1,4n /1.`vP�
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
./ Ph sical Presence or Online Notarization
this day of 2020 by
this day of 7g41?_ 20J by
To1�.a' Ueor'a�
Name of person making statement.
Name of person making
;.�pav'auBG JONATHAN D REXFORD
Personally Known OR Produced Identification
Personally Known Vgt& ftrcgfI8Af Florida
Type of Identification
94
Type of Identification `:,,� oQ Commission NsA r
• •.9,F�• My Comm. Expires Apr 19, 2024
Produced
Produced encied through National Notary Assn.
(Signature of Notary Public- State of Florida }
Signature'of Notary Public- State of Florida )
k 4f3OK
Commission No. (Seal)
Commission No. `/G (Seal)
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—J
ev. 5/6/20