HomeMy WebLinkAboutimg224All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `% ' 2 2,0 Permit Number:
P, >s G -D�- n C,.. Building 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 EOR:,I���
lddress: 1,Q 7
Property Tax ID #: 3 i - 70 t� l �S -000-57 Lot No.
Site Plan Name: Block No. —2—
Project Name:
New Electrical Meter Second Electrical Meter
Additional work to be perforated under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors Pond
_Electric dumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ __4 / i Utilities: —Sewer _ Septic Building Height:
Name r'4f4C(_ I K r(
Addres • tc ii L C".,4
City: F-2:7 5i / LtL/ L ` State: (_(--
Zip Code: 3 X95 Z Fax:
Phone No. _77Z- 5 217_0&_/
E -Mail: F130 V &/4 0 7 Ld 1f0 ,qdl • CUt�
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name:
/O ii'. Gib
Company: UuA 17' t q46 W6- f
F
Address: G 0 X t `{ �
City: 0 T- _ S'4CC-4N i) State:
Zip Code: 3't 9 1? Z Fax:
Phone No % 7 2- Z Z0 7 5 7%
E -Mail 1,14r -OC, -2 ?C CJCq 6 /A,;
State or County License GFG (Y30�k�
rl valuc u, tvnsurucaion is caw or more, a KtLunutu notice of commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: — Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
— Not Applicable
State:
Not Applicable
-.—Gni ti.,%n-4 r rim- r un mrriuvi 1: 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 ur Notice of grnmencement.
7 II \ Z In \
Signature of Owner/,Lessee/Contractor as Agent for Owner
STATE OF FLORID
���
COUNTY OF
Savoy4o (or affirmed) and subscribed before me of
Lf Physical Presence or Online Notarization
this -I— day of JQ_ (VC 2020 by
Ar4X)n4 h V Ire f b _
Name of person making statement. to III/,
.,VA -Nn. �.✓
Personally Known OR
Type of Identification
Produced FLPI—
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(Signature of Notary Public- State F1' a )POeV..�
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Commission No. , , OF %0:1lllll�<<�
Signature of Contractor/license Holder
STATE OF FLORIDA
COUNTY OF jo & h n
Swrto (or affirmed) and subscribed before me of
40,%PPhysical Presence or Online Notarization
this _ I day of J V (vc— 2020 by
Name of person making statement.
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Personally Known OR Prod `�_
Type of Identifi io �� Q. •.•••"'•••..• /- ��
Produced �� •.yap?AR y •ti• 0 .�
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(Signature of Notary Public- Statd�pf Frvrhi h
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Commission No. toll
REVIEWS
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
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REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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