HomeMy WebLinkAboutSt-Lucie_PermitAPPAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
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 LIL4 Pa Irn 5 A u e_
Property Tax ID #: 3 y 0 3- S 01- 01 r S -00 0 -3
Lot No. 17
Site Plan Name: _ Block No.
Project Name: 4c
n r e- l Ce,
DETAILED DESCRIPTION OF WORK:
rl a)'; 0Y MEcui I' -- InS+a[l Ih a 1; cA•t
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 _ Windows/Doors Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction: $ 'Z�-�', 5 5 Cs, • Z Utilities: _ Sewer — Septic Building Height: _
OWNER/LESSEE:
Name
Address: 3 LN im S A ;r
i city: fo-4+ e're,sG2 State: F1
Zip Code: __3 9 Fax:
Phone No. 7 ? 2 - g016 - 36 3
E-Mail:_jr l Ig5.75W 00IDIcof 1,
Fill in fee simple Title Holder on next page ( if different
tfrom the Owner listed above)
CONTRACTOR:
Name: M ew (
Company: IMP 01z)
Address:P~ L
City: YVXOn R Ib State: F 4,
Zip Code: Z l+ Fax:
Phone No 50 . _7 . 13 1 3
E-Mail
State or County License C Qj C. lZ 5 -7 3 5 r�
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.
W
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNS
Name:_
Address:
City:
Zip:
EER: _ Not Applicable
Phone
State
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:_
Address:
City:
Zip:
Phone:
Not Applicable
State:
BONDING COMPANY: Not Applicable
Name:_
Address:
City:
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 N e of Commencement.
Signature of ner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF r� l kA6 e-
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
/ Physical Presence or Online Notarization Physical Presence or Online Notarization
this ay of O E , e-r 12020 by this day of , 2020 by
rJ-k—y Pa,J .L,0,fl.L-Q4
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
`,,`>> C�Nhy
Produced I
"r��'�•
'(Signature of Notary Public- StateSf MAO) �
Commission No.
REVIEWS FRONT
i COUNTER
DATE
RECEIVED
DATE
COMPLETED
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A%iP'b._�9lldwd %Vt
Personally Known OR Produced Identification
i Type of Identification
Produced
(Signature of Notary Public- State of Florida }
*=
Commission No. (Seal)
ZONIN(YlojryjWWR'VISOR ' PLANS I VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW