HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMr�Z ED FOR APPLICATION TO BE ACCEPTED �1 ?
Date: . -R-ab Permit Number: O6-
RECEIVED
Building Permit Application JUN 15.2020
Planning and Development Services
Building and Code Regulation Division Permitting Department
St. Lucie Coun
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE: G Qhe(g}ar
PROPOSED IMPROVEMENT LOCATION:
Address: !�30 Lr ()uirre5% dl > v e
Property Tax ID#: 23D2, 561- ONG-PIS D/10 Lot No.
Site Plan Name: Block No.
Project Name:
I DETAILED DESCRIPTION OF WORK: I
N INFORMATION:
Additional work to be perfor ed under this permit- check all that apply:
Mechanical V GasTank _Gas Piping _Shutters
AL Electric _Plumbing _Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 7-6 Q �O n
Generator
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic
Windows/Doors
— Roof
Building Height:
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name iPaOtIA A4oi
Name: 6LJrw-r bL&&S&C
Address: ASO W c oACr t
Company:
City: 2� State: I�L
Zip Code: 34%45 Fax:
Phone No._ J)a-ri(i,- 9-'?qD
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail:Rp_gu�j IQ 6,ft Oh Can
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
If value of construction Is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAIN:INF0R''MAT'10N
_m
DESIGNER/ENGINEER: _ Nat Applicable MORTGAGE COMPANY: _ Nat Applicable
Name: Name
Address: Address:.
City: State: = City State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable I BONDING COMPANY: _Not Applicable
Address:
Zip: Phone: I Zip:, Phone:
OWNER/ CONTRACTOR AFFIDVIT: ADolication is herebv made to obtain.a Dermit to do the workand installation as indicated.
I certify that no work or installation has commenced priorto the issuance ofapermit._
structure. c m can Teti with any h your Ho Homeowners Association rules, by our de d covenants that may which
may
a prohibit such
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 will, in all respects, perform the work
in accordance with the approvedplans, the Florida Building Codes and St Lucie County Amendments.
The following building permit applications are exempt from undergoing full concurrency review: room'additions,
accessory structures,_swimming pools, 'fences; walls, signs, screen rooms and'accessoryuses to anothernon-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 recordedin the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
.,ilti 1—4— �n ln.f~. Tnromnnrina ... rA, nr m,nrrliNv wnur NntirP.nf CnmmPnrPrnPnf_
S�natute of Owner/Lessee/Contractor, as Agent for Owner
Signature ofContractor/License Holder
STATE OF FLORIDA ii''
L i
STATE'OF FLORIDA
COUNTY OF
COUNTY OF TC . CLC
Swoto (or affirmed) and subscribed before me of
Sworn to (or affirmed)and subscribed before me of
FhystcalPresence or_ Online
_.. Physical Presence or. Online Notarization
this l� dayof J unl Q - , 2020 'by
pn 1- QV' ;(14f
this_ day of . 2020 by
Name of person making statement.
Name of person making statement.
Personally Known V% OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Pro
Produced
r
(Signature of Notary Public- St teo qli a I
ig
ature of Notary Public -State of -Florida )
SHARON DEF ORI
Commission No. lac Public State of
Csc o I•S jjy y
I m
-
fission No. (Seal)
- Commission N GG 04
'+o..tQ
576
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My Comm. Expires Oct 2
, 2D20
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