HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE LETED FOR APPLICATION TO BE ACCEP1,_P
Date: Permit Number: 10-053 V
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Ell LL CO.. I E DI! r_ Building Permit Application-
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34982
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: L-Cl-I
- _
Site Plan Name: Block No.
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter (Affidavit required)
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:-
Utilities: Sewer Septic Building Height:
Cost of Construction: $ OOLD
OWNERAESSEE: CONTRACTOR:
Phone No.— 7-- Zip Code: Fax:
Fill in fee simple Title Holder on next'�page if different E-Mail SoAV-Pvf�!5cyee�s'e
from the Owner listed above) State or County LicenseSISM
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.
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SUPPLEMENTALrCONSTRUCTIOi�I LIEN LAW IN,FORMATIQN
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: WA%nNJr, Era;neer c+ ) Name:
Address: 5601 AAoZ%r er 5k' 2-q0 Address:
City: 0. State: FI• City: State:
Zip: *M Gl Phone T13-v 14-01,403 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 fo'obtairi 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 Nome Owners Association rules,"bylaws or and covenants that may restrict orrprohlbit such
structure.Please consult with your Home-Owners Association-and teview.your deed for any restrictions which may apply.
In consideFation of the granting of this requested permit;I do hereby agree That I will,Wall 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 use to another noh4e'sid'ential 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 attorne 'before comrnencih "wor`k or r'ecordin • our Notice of Commencement:
Signature of Own r/Lessee on r Owner
STATE OF FLORIDA S+ L
. / CII
COUNTY OF
Swt,tp(or affirm$�d)ands bscribed before me of Physical Presence or Online Notarization
this day of V Cifier' ,20,! by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identifica 'on Produced F 1. 11102AS IrCrdls�
(Signa re of Notary Publi S to of Florida)
GINA JOLLY
Notary Public-State of Florida
Commission No. (Seal) _, •= Commission# HH 118997 '
My Commission Expires {
April 19, 2025 ,
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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 5/20/21