HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMP.�_-21) FOR APPLICATION TO BE ACCEPTED
Date: it, 1 1qa- Permit Number:
2'T. I L U C H I E ` -
o -- -.
IDBuilding Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED UPROVEMENT'LOCATION
Address: ) Bro AL 34915
Property Tax ID #: i 31`3g3 0 0 Bow Lot No.
Site Plan Name: C) A l ► Block No.
Project Name: I i) 1U
DETAILED DESCRIPTION'OF WORK:
51 en ixeer=ee� QV rl /1 ec(-a
e_oc - 51-,
New Electrical Meter Second Electrical Meter
CONSTRUCTION .INFORMAT'1ON„ :_
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: 36
r %
Cost of Construction: $ / % 7. S Utilities: Sewer Septic Building Height: al
�tJUUNER%LESSEE.,= = _ `. .- .
CONTRACTOR:
Name
Name: kt r�on r►s(-cr
Address:
Company:
Address: /0 S ! O/ D
City: -= St e:/
Zip Code: Fax:
City: Verb State: L
Phone No.
Zip Code: Fax:
E-Mai}l1�lt/�/�.�/T/ � �
Phone No -7i14'569—W(v.,
E-Mail }�Ir lS ir_� a,�� (�ci n I . Mm
-
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License_ tS 10 001'g04'
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.CNSTRUCTION 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
is in Home Owners Association bylaws that
which conflict with any applicable rules, or and covenants 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.
Signatur Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF n Ai a,,,, 12w,,y
COUNTY OF j n&. A,,, Jvvo;ny
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
_ Physical Pretence or Online Notarization
this j day 2020 by
thi � day of 2020 by
_ V 1
e,Dm Aaasm re-
Na a "son making statement.
Name of person making statement.
Personally Known OR Produced Identification _X
Personally Known �_ OR Produced Identification
Type of Identification
Type of Identification
Produced 3)L. o5m - I) • %(�, Q�P - O
Produced
T%j fl,
y. L.
(S ture of Notary Public- S ate of I i
ature of Notary Public- Stat o I
,�FyY'P�B,•: DIANAL. BRYANT.............,
Commission No. �`�OQ:°; �lpotary Public State of F
# GG 940
a •. DIANA L. BRYANT
ml55ion NO. =o; �„ ry Public . State of Flo
commission GG 94006
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Commission
My Comm. Expires Feb 22
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+�My Comm. Expires Feb 22,
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°F"' National Notary
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DATE
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DATE
COMPLETED
ev. 5/6/20