HomeMy WebLinkAboutPERMIT APPLICAITONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Hate: 24, °Z Permit Number:
sr, L-i1LflL
�~ � U L, k Y Building Permit Application
Planning and Development. Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL P4982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: I.3 10 Cis P4EM H AV 1=��
Property Tax ID #: �J I
Z3
DOO S ^ 0 CLQ
Lot No.
Site Plan Name:
=Y Cr'
L r �C
Block No. WAD
Project Name:
P DETAILED DESCRIPTION OF WORK:. I
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION: I
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:
Cost of Construction: $ 100
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNERAESSEI :
CONTRACTOR:
Name -e r � ?fit_" `7L -fir'
Dame: 4 4-4 +S -w 4 -TI-!
Address:.... IS I +Q OUP E,14 0A',(O
r
city:—'ate +� i a� e Stated
Zip Code: _ 3 q ` S Fax:
Company: -3-
_
1E 1 CA -C cy L..I_C
Address: -7'603
R,, .� �"/s ,
City:
Stater_
Phare No. `7 `7 3 `7
E -Mail: ren'-)
zip code: 3g
Phone No ( 17 Z) 5-11
Fax:(-L7z zLi«
0_2- 3 3 _
�
Fill in fee simple Title holder on next page ( i€ different
E -Mail E
-�&'K� t � e 5"
State or County License-C-a.�
from the Owner listed above)
If value of construction is 2SOO 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.
SUPPLEM ENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City A State:
City: 4 State:
Zip: 1A Pho a
Zip: on
FEE SIMIPLE TI L HO ER: N t Applicable
BONGING CO PA 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.
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 Jender or au attorney before cbmmencine work or recording your Notice of Commencement.
/
Sig re of ntractor/License Holder
Signature of Owner/ Lessee/ ntractor as Agent for Owner
STATE OF FLORID
STATE OF FLORIDA
COUNTY OFA
COUNTY OF.,A`C:�)
i
Swo to (or affirmed) and subscribed before me of
Sw0y0h to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Presence or Online Notarization
this 11 day ofWQMV 2020 by
thiW
s� day of �� 2020 by
`�
kk �l ( '►^��kt'k al�
Name of per n maki g statement.
Name of person maki 'statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of I entiftca ' n
Type of Identi cation
Produce
Produced
KA;�_ RANDYIV MCNAMARA
I;' N MCNAMARA
5i u e f ota tL4'6 g4d�IKII 10N # GG032190
( g N
1 N # GMM
(Signa ure of N ary
EXPIRES November 27, 2020
XPIRES November 27, 2020
Commission No. (Spal) -
Commission No.
REVIEWS
FRONT
ZONING
SUPERVISOR
PIANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
nev. 010/ zu