HomeMy WebLinkAboutBUILDING PERMIT APPLPICATIONAll APPLICABLE INFO MUST BE'-W- MPLETED FOR APPLICATION TO BE ACCL -. -1J,
Date:
Planning and Development Services
-Building and Cade Regulation Division
Permit Number.7,01 - D(s ?<)
SCANNED
BY
Building Permit Application St. LucieCounty
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Address:
Commercial_ Residential
Property Tax ID #: :)g I S ^ 7O I - (0 C),('n < - bzU C) - 7
Site Plan Name: S. L uC--( C QKA t H,3 U s e-
Project Name:
Lot No. //
Block No. -7
DETAILED DESCRIPTION OF WORK:
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4p,.3 L'fio ck
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
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Additional work to be performed under this permit -chec.kall'tb'atapply;.�n:,�-=.;��_-�-�:••m
_Mechanical _Gas Tank _Gas Piping
_Shutters. Windows/Doors _Pond
Electric —Plumbing —Sprinklers
_ Generator _ 1)oto�f Pitch
'Total Sq. Ft of Construction: Sa
f
Sq. Ft. of First Floor:
Cost of Construction: $ WB�' , Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: -
CONTRACTOR:
Name =•_ L rri, Hc a F-
Name:
S
Address: 30 S L75 N
City: Ir�rz lI ST UC i Stater a,' la
Zip Code: 3 J 9 '� 01 Fax: —' + ^ 3
Phone No. 7% ZI (n\ I • a33 SS
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Fax:
Phone NoZ?Z-Z4[90 f
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail % x4lc .1%pvr4 SCS rvt. -
State or County License C6C-JC-ZqT, 69
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- _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: i State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
City:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
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�tructure
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.
Inconsideration 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 exemptfrom 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.
Signature of Owner/ Les e
tr c r s Agenttor Owner
Sigfiature of Contractor/License Holder
STATE OF FLORIDA ?
as Nohry M� PI .Bate of FloCHAND KRLUSCOMI Florida
OF FLORIDA
COUNTY OF
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OUNTY OF
My Comm. byres Au 16, zozo
°s`dr�8ed
Swo a
( or affirmed ) str�
9oadrifMNP ftiilonal luyAssn,
wom to (or affirmed) and subscribed before me of
Ph�n ysical Prescce
n e a a o
_Physical Presence or Online Notarization
this /'S',day of �_.
, 2020 by
this _ day of. 2020 by
Name of person making statement.
Name of person making statement.
Personally Known �R Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(' t re of a blic- S
Si nature of Notary Public -State of Florida )
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REVIEW
DATE
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DATE
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