HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q
Date: Permit Numb :_3100 617
91r. [LUC�C� 'P
O
JUIN 2 2020
Building Permit Applicati n
Planning and Development Services
Building and Code Regulation Division Commercial R sicr&htlal;c; UL
2300 Virginia Avenue,Fort Pierce FL 34982 --�
Phone:(772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR: Q11�rj"���g
'PROPOSED IMPROVEMENT LOCATI,O.Nj'.
Address: VI I U Ori&bze_" L A e.
Property Tax ID#: 3 y a l.0 - 0 7� ~d I S`1 -000- 0 Lot No. it L13
Site Plan Name: Block No.
Project Name:
[OETAiLEODES-CRIPTIOWOF WORK s 1
Acc u(-d i c r, fxAnr rrl SAo-k-k6`S Ch -,:;S w C v-A `I Fronk
f s WR u)rndao &A C`,co se PpftcV_ are-k wckb Acc"�c�►9�
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 A Shutters _Windows/Doors _Pond
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 49 00. 0 b Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:`: :r .: CONTRACTOR:
Name (ZOSc� i cx i D Name: �eU t �J !l-?i ck-a I5
Address:
Company: AnyX iCity: QS L State:f Address:Jqqa. —"',W� SKul
�
, s�
Zip Code:_3 4 o1 S 3 Fax: City: Q C>L Stater
Phone No. I )-^�_-CKS-)kgLQ'1 Zip Code: 3 Nit 5.3 Fax:
E-Mail:HP60 Q,t(\P J i q51 9!_�i^ng�i. U K` Phone No -110,- 603- `1`�d�-
Fill in fee simple Title Holder on next page( if different E-Mail 'Ml 0-0 rnru I • Co p---
from the Owner listed above) State or County License
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 LIN,LAUV'I'NFORMATION v R
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: K 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.
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 2 44Z r Q COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sw r to(or affirmed)and subscribed before me of
Physical Presence or Online Notarizationh sical Presence or Online Notarization
tis day of J,i on ,2020 by this%day of� y'ii f ,2020 by
4eu ylnlicJge-) 15 -eUiV) /` (Chn /S'
Name of person making statement. Name of person making statement.
APersonally _ R Produced Identification Personally Know OR Produced Identification
on Type of Identi ation
Produced
(Signatur of Notary Public-State of Florida) (Signat re of kMary Public-State of Florida)
"'Sky pu", ALYSSA A.T.BOWSER �o1a�'!.P�e(� ALYSSA A.T.BC W R
Commission No m ' ( eatJ mmission#GG 295930 COmmissionNo.[�� y��s%�GM
., f* Commission#G 2 930
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Expires January 28,2023 Expires January23
s -4Bonded Thru Budget Notary ServiceFp
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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