HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE I FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �e_L
Permit Number:
-
P RECEIVED
Planning and Development Services Building Permit Application DEC2 9 20
Building and code Regulation Division Commercial st,l er' ry
ReSldentl
2300 Virginia Avenue, Fort Pierce FL34982 al _- Per ing
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PRO:POSED-1'M PROVEM ENT.LOCATION:
Address:
4'2L
Property Tax ID#: (p
Lot No.�_
Site Plan Name: .r� 3��
�/w t ck No. rZ
Project Name: , �\
e4'\- -- ve_vc
DETAILED DE-S�C l PTI0N:OF WORK:
New Electrical Meter.Second Electrical Meter
(Affidavit required)
CONSTRUCTION IN.FORMATIOIV
Additional work to be performed under this permit—check all that apply:
—Mechanical —Gas Tank _Gas Piping Shutters
— _Windows oors _Pond
—Electric —Plumbing Sprinklers —Generator
Total Sq. Ft of Construction:_ � � .
7 oof _ (e. log— Pitch
Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: :CONTRACTOR:
Name_ �+ ��
Address:_ Name:. �� 'nCq0ve
'1 �AY�Ci � L��� an
Com d
20C� � C�� Company:
City:
State:� Address:
Zip Code:. Fax: City:
Phone No. �Fj State:
�n nA� �� E- Zip Code: ����I Fax:
Mail ,Ct�( X Phone No "1 ' 1
Fill in fee simple Title Holder on next page (if different E-Mail Mgr,,t�,,r � eo
from the Owner listed above)
State or County License erg N12 \ a
LI If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
f value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
SUPPLEM'ENTA�L.CONSTRUCTLON LIEN LAW INFQRIVIgTION
DESIGNER/ENGINEER: ___ Not Applicable
Name: MORTGAGE COMPANY: Not Applicable
Address: Name: .—
City: Address:
State: City. State:
Zip- Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY:Name: — Not Applicable
Address: Name:
City: .Address:
Zip: Phone: 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 P that is granting which co g a permit conflicts with any.applicable Homeowners Associatio rul ,bylaws or and covenants thatemaybres rict or subject such re
structure. Please consult with your Homeowners 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 failui•6 to Record a Notice of Commence improvements Commencement m p vements to a result in
Your property. A Notice Of Co Y paying twice for
. Commencement
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain finlancing, consult
with lender or an attorney before Ommencing work or recording our Notice of Commencement.
Signature of ner/Lessee/Contra , or as Agent for Owner
STATE OF FLORIDi, 1
COUNTY OF - lilt r,c�
Swor o(or affir d me)and subscribed before of
this day of 201A bY Physical Presence or Online Notarization
Name of person making atement.
Personally Known OR Produced Identification
Type Identificati n Produced
(Sign ture of Notary Public-
State of Florida)
Commission No. ` ' (_(q(�eal) 00�P�m�, DENISE ELAINE SUAREZ
-Notary Public-State of Florida
°• •' Commission M HH 52997
My Commission Expires
October 13, 2024
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