HomeMy WebLinkAboutBUILIDNG PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
91r. WCfl
O
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Port Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: x I I I 1{� _ I` t k
�1
PROPOSED IMPROVEMENT LOCATION:
Address: Sl.
Property Tax I #:.31Ia5 -TOE-00Ct3 QQ2 Lot No, 10
Site Plan Name: PVC lu l i- lb R CJL (W1 - U ) Block No. -310
ti 1 i _ ►1 I —1_ 1 1 -'1, kr a
Project Name:
I DETAILED DESCRIPTION OF WORK: I
New Electrical Meter�Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
Mechanical — Gas Tank
_Electric 4Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
_ Gas Piping
_ Sprinklers
Shutters
Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Utilities: _ Sewer — Septic Building Height:
OWNER/LESSEE:
CONTRACTOR
Name�� _• . •:
y {
Name: 4e, 7
�! r`✓l WV1
Address: �{`
Company: M cc rriG
p Y�
City: ��[� L��C State:
L
Addr s: L C
State:ZipCode: —G,
Phone No. 17a-S'73 -$53_0
Zip Code: Fax: *Z-$� 1- �'�,9
E-Mail: Q2 roAs� [_7vvi
Phone No _-F(` 9 L C
Fill in fee simple Title Holder on next page ( if different
E-Mailer rrh14rc �, � vG.rtvrr l0ku P-ibe►', cU.vc
from the Owner listed above)
State or County License C �c /y
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 CONSTRUCTION LIEN 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 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.
,41
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF 51 �-UG
STATE OF FLORIDA
COUNTY OF 51 Lur r e,
S5an to (or affirmed) and subscribed before me of
P ysical Presgn�ce or Online Notarization
this I day of 11((iVel V 7 _' 2020 by
(or affirmed) and subscribed before me of
✓ P�iysical Preseppe or Online Notarization
this y7 day of A✓CIteQ_7TL , 2020 by
a a c,_
k4a- 3 f6-c -L
Name of person making statement.
Name of person making statement.
Personally Known -/ OR Produced Identification
Personally Known '� OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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(Si atur
,;fir: "~• JULiE JAN:IAAULDI
Commissi Notary A�blic
..,` My Comm. Ex.:
(Sign ure
vi" JULIE JANE MCCAULEY
Nagry Peiblic State of F
CommissioHN 498Z4 "n
` My Comm. Expires Oct 1, 2024
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