HomeMy WebLinkAboutSigned Building Permit Application}
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
�M LUC E
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITAPPLICATION FOR: r�.kvv� A-C S}uI cry{io
PROPOSED IMPROVEMENT LOCATION:
Address: � �J kQC'"\AS 9�Iyr� i �n�l\ 0��kfl�
PropertyTax ID#: r4 501 ' 501 - C)AOi - OW a Lot No,
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
1� C
New Electrical Meter
Second Electrical Meter
(Affidavit
required)
CONSTRUCTION
INFORMATION:
Additional work to be performed under this permit —check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters
_Electric _Plumbing _sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ �JI a L7
_Generator
_Windows/Doors _Pond
Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:Q 1p\ h CLkQ au� 66��
Address:\3 N C E-c125 (2SIVCk
Company: Skeptim��:�(�o
City: �CC�SCC1 LSCrmclA State' L
ZipCode:SL\01S0 Fax:
Phone No. L4Vf `J�Ci 3
Address:Il 419 Sr Y &rchk
City*AAO gShvfx� Stater
Zip Code:S3C-1 SS Fax:
Phone No_5CRI`(JL`a -A300
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail_0(� tg Q, 0(�W (�4(rrdtS C ,Co(h
State or County License E lc \W?s014
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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SIJRPLEMENTAL CONSTROCT�QN I.lEN LAW I�1FfJRMA7101U.
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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
BONDING COMPANY: Not Applicable
Name:
Name
L
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 Count makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is In con lIct 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 r an attorneybefore commencingwork or recordin our Notice of Commencement.
o wner/Lessee/Contractor as Agent for Owner
7Sign
TE OF FL4IRID�\
COUNTY OF ���Vn�
M
Sworn to (or affirmed) a[[�1d subscribed before me of �' Physical Presence or Online Notarization
this ',�dayof " t>K 20`Aby .
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced fv �,1; i-•
(Signature of Notary Public- State of Florida) f Notary Public $fate of Florida
Ma
Amanda
Commission No. (Seal) My Commssio0 GG 935496
L4K) Expires 12/0112023
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