HomeMy WebLinkAboutNoterized Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
S�r�' L C-L11: R
c F2 �L 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 FOR:�,d
PROPOSED IMPROVEMENT LOCATION:
Address: Q&.CA _1 . PP\k LDC Y3
Property Tax ID #: -'150J _ '�2Ci _u. -U- - U -�P Lot No.
Site Plan Name:: 012.tr" �' c1� U'C4�- r�U'M���U'M Cam_ DZs>,, _oC lock No.
Project Name: —Cc"--y"
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
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: $ k . �00 ,00
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Nameg tilk' ► �l.X__�P�`_�
Name: I:tC'(N foI \fib
-.--
Add ress:'�l(A'-IU'3CX;_ n T)c • P�P"t LePlb
Company:__�(CffNM IN '6\\x_�c
City: �ri���1. YJCCCY1 State: � ll
Zip Code:1--1C1'5-\ Fax:
Phone No.n1 5 -1 . 2 '
Address: 235L
City: "a \- State: 1
Zip Coder 1`1' 1 Fax:
Phone Not- 'X� I•
E-Mail:�l(X�1�G`Z LAC�t>C-fx�rl.
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E--Maii_Y t`.y YiCT-�c�CYl
State or County License
is value or construction is Z50o 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: 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
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 our Notice of Commencement.
7
Sifnature of Owner/ L ssee/C tr for as Agent for Owner
Signat a of ntractc r/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF ST_ LrvG�
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
K Physical Presence or _ Online Notarization
this b day of 'Jy Nl= 2020 by
Sworn to (or affirmed) and subscribed before me of
}C Physical Presence or Online Notarization
this day of b 2020 by
_jr7ppololio
ho
l
Name of person making statement.
Name kf person making statement.
Personally Known _ y OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
at of tary Pu c- e o on
Its OWY u 6C Stare of Florida
semis n No.6b4 Michael coe1l=JMW
g,�itis��
orr4 Expires ► 24
(Signature of Notary Publi - State of or' Notary Public state
Michael James M
Commission No. ► ���SZ-� I My Commission G
Expires 03118l2g24
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE:
COMPLETED
Rev. 5/6/20