HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED c�
Date: Permit Number:
RECEIVED
1 JI��ICIlL� ;0'
o OCT 12 2020
- Building Permit Application St.Lucie County
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 CBDG Funding
PERMIT APPLICATION FOR:
FR�OPOSED �MPROUEMENT LOCATION:
Address:L�QC� �a �`�k,f-P- �f�'�-fir /Q R77-
Property Tax lD#: �`\ aa' G ,6 Lot No.
Site Plan Name: Block No.
Project Name:
I
DETAILED 0Ea5CRIPTIC}N OF —L- -A
WORK
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INF®RMATION:
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Pond
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ Utilities: _Sewer _Septic Buiilding Height:
OWNER/LEWIS CONTRACT®R:
Name Name:
Address: co ��� �� Company:
City: St ate:F--e— Address:
Zip Code: Fax: City: �. .. State:'
Phone No. 7'7 — a3-7— E- Zip Code: Fax:
Mail: t ��� b t vv\Qv.� c7w� Phone No
Fill in fee simple Title Holder on ne t page' (if different E-Mail _
from the Owner listed above) State or County'License
I
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.
SUPPLEMENTAL C«ONSTRUCTtO lt?N LAW INFORMATION:
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 authorize the permit holder to build the subject structure
which conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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.
Si nature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF Sic-
Sworn to(or affirmed)and subscribed before me of Physical Presence or Online Notarization
thisVa day of 20a\ by
d sy G vl -)-h
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced L
(Signature of Notary ublic-State of Florida)
Commission N E (,Seall
y Fue• Public,State p86359
Notary mission NH 28 2025
Com ices tan
Comm.ExP tonal Notary Assn.
REVI ONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev5/20/21