HomeMy WebLinkAboutBuilding Permit AppAll APPUCABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: L c Permit Number:
Building Permit Application
Planning and Development Servkes
8ulldiog and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort PierceFL 34982
Phone: (772)462-1SS3 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID R:
Site Plan Name:
Project Name:
I DETAILED DESCRIPTION OF WORK:
rl - T r
U0 2
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Attional 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: S .rl PR 1, W
Generator
Lot No.
Block No.
T Windows/Doors _ Pond
Sq. Ft. of First Floor:
Roof Pitch
Utilities: — Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Scknr, ticH
Name: 05}l0c, p
Address: 1 nq a c.n
1
City:'POA � L !C-; Q State: I
Zip Code: Fax:
Y� Com an Air
P
Address: 36 4h d�
'
City: e_f ,:11 State: i
Phone No.
Zip Code: 'TLrI (t 2 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 25W or more, a RECORDED Notice of Commencement Is required.
If value of HAVC is $7,S00 or more, a RECORDED Notice of Commencement is required.
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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.
1 certify that no work or Installation has commenced prior to the Issuance of a permit.
St. Luck County makes no representation that is granting a permit will authori2e 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 yqu intend to obtain financing, consult
with lender nr an artnrnev hefore commencina work or recordine vodr Notice of Commencement.
Signature / Les
ntractor as Agent for Owner
Signature of ntractor/License H er
! STATE FLORIDA
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STATE O FLORIDA '
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COUNTY OF "
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COUNTY OF
to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical PresWFe or
Online Notarization
_%Physical Presence or Online Notarization
N
this _�' day of 1V 0V9,mL4
✓ .2020 by
this -E� day of a. 2020 by
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Warne 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
Prod
litit
Produced
(Signatur ry P
YN I BELL
(Signature tary Pu )LyN I. BELL
,fit
Commission =•: 1(yEJIiCa(3170351
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Commission o. .; �,2021
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25.2021
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 576725
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