HomeMy WebLinkAboutapplicationAll APPLICABLE INFO MUST BE
Date: G 13 1 yoz�
ED FOR APPLICATION TO BE
Building Permit
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
PERMIT APPLICATION FOR:
Address: '7 5 7 0
Property Tax ID#: NX0-\y
Site Plan Name: C t
Project Name:
New Electrical Meter
LA.
-..
Second Electrical Meter
Permit N
SIL_
Additional work to be performed under this permit - check all that apply:'
_Mechanical _Gas Tank _Gas Piping _Shutters
_Electric _Plumbing _Sprinklers _Generator
Total Sq. Ft of Construction: �((,�� Sq. Ft. of First Floi
Cost of Construction:$ Il(lU'o Utilities: Sewer
RECEIVED
SEP_3.0 2020
Permitting DepertmeW
ial St. Lucie County
Lot No.
Block No.
JVindows/Doors _Pond ~'
I' Roof-,)!i " Pitch -
B �ilding Height:
OWNER/LESSEE:
Name c
CONTRACTOR
Name:
Company:
�
IAddtess.' '
City: "
Zip_Code::,'
No
E-Mail
State or County License
Address: 3i' 3 N
�•
city: �� lir'Ct�
y State: �L
Zip Code: 3� Fax:
Phone No. 5 1 b (� I) 15 j
�I1"1
State:_
Fax:
r'
E-Mail:fttr CSSty Jr-c r. n L}rna,/, c4h,Phone
Fill in fee simple Title Holder on next page (i) different
from the Owner listed above)
a�a
I
If value of construction is 2500 or more, a RECORDED Notice of Commencement is
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is requ
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFOR
DESIGNER/ENGINEER: _ Not Applicable
Name:
ATION:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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
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 attorney before commencing work or recording Your Notice of Commencement.
U & ,r, I
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA `
STATE OF FLORIDA
COUNTY OF . =Jjo 1 C ,
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
ysical Pres rice qr_Online Notarization
Physical Presence or Online Notarization
this day of . 20� by
this _day of 20_ by
`.,( )CX:w 24Q,4.i,i
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification'
Personally Known OR Produced Identification
Type of Identific ' n
tL
Type of Identification
Produced
Produced
(Signature of Notary Public-
State of Florida)
(Signature of Notary Public- State of Florida )
10 ".e S. NIELSEN
-;State rida-Notary Public
Commission No.
Commission No. (Seal)
Commission 9 GG 207484
e M
..` Jun
12, 202E
REVIEWS
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VEGETATION
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MANGROVE
COUNTER
REVIEW
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REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev. 5115120