HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I Cl a.o� 1 Permit Number:
O
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Residential
PERMIT APPLICATION FOR:
PROPOSED.IMPR,OUEM,E ,T LOCATION., ' Y�� g
Address: �
Property Tax ID #: i CC) % - 0 d� i0 _ noo - q Lot No.�
Site Plan Name: _ LMK e—-?t9a:& 2a A \ '( i' c - -] Block No'.
Project Name:
DETAILED DESCRIPTION:OF�WORK
:
New Electrical Meter ✓ Second Electrical Meter
CONSTRUCTION'INFORM/,aTION:
Additional work to be performed under this permit- check all that apply: ..
U/-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: $ 1 t)QTgCj n Utilities: —Sewer'
_Septic
Building Height:
OWNERAESSEE:
CONTRACTOR`
Name
Name:
r -nog`
Address: 10D
Company:
_
f
City: PC- , Q Q1rci State:Il
Address: -02- J C, 4'1 S+
Zip Code: 3591r6 Fax:
City: 2('ce-
State:_rC
Phone No. 7-1-2 - yY Ail y .
Zip Code: 3y olSb Fax: .
E-mail: ��S�h �d-`ctC%e �lab� �..a�m
Phone No 7- oL- L161-1- it -
Fill in fee simple Title Holder on next page (if dill re ent
E-Mail h"
; 4-"t-al
from the Owner listed above)
State or County License.
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:
Name:yJ 2 1OA,Se�
_ Not Applicable
eA4) tAe.er1 rL
MORTGAGE COMPANY:
Name: Gk- U,,,,e \AL ,kA fie;
Address: -Wk S r.+k 5--.
City:
Zip:5'4QZ0 Phone: -7-7�)-
Not Applicable
1�lv.man �� y
State: `L
c►Lcf-llt7
Address: Hcisl G+ Lucie_G3 vc1
City:State: _T-L
Zip: 3Ha4tfl Phone -i-7a- 1-l6q.-LaoS
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
_ Not Applicable
BONDING COMPANY:
Name:
Not Applicable
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 attornev before commencing work or recording vour Notice of Commencement.
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Signature of Owner/ Lessee Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA,
STATE OF FLORIDA 1
COUNTY OF �y-. (
COUNTY OF
Swo1n to (or affirmed) and subscribed before me of
i to
S'r� to (or affirmed) and subscribed before me of
Presence or Online Notarization
y Physical Presence or Online Notarization
this day of 2020 by
this day of 2020 by
Name of person making statement.
Name of person making statement.
y
Personally KnownOR Produced Identification
Personally Known ✓ OR Produced Identification
Type of Identification
Type of Identification
Pr uced
Prod
aeed
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(iWl/mi 161,
ignature of Notary Public- State of Florida )
(Signature of Notary Public-
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Commission No. `� 1.1W Lea
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Askman
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REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 5/6/20