HomeMy WebLinkAboutColon Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
0
9 ` 1 A 0 ",' 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: (C)C+ 4J j" f j)IMJC
PROPOSED IMPROVEMENT LOCATION: Ham-, II !! r r
Address: 3 S S Ca /' c w i &r 1c �/� � .� PC3 51. L _ t_[, C 2.q- I r` Ir' 3q-vl /0'30
Property Tax ID #: D'? ��'-1 _ G t2 - ti Lot No.4
Site Plan Name: Block No.
Project Name:...al on aulc -
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
I CONSTRUCTION INFORMATION, {
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping Shutters wZRo
sjDoors _ Pond
Electric _ Plumbing _ Sprinklers _ Generator f -7 — Pitch
Total Sq. Ft of Construction: a Sq. Ft. of First Floor:
Cost of Construction: $'f Utilities: —Sewer _Septic Building Height:
OWN ER/LESSEE:
CONTRACTOR:.
Name `*tkL oaof)
Name: r v r•` ' &sIr -W .ten
Company: �orl Ii g
Address: .33 F [�f�
City: Ef AUW State: 'F- i
Address: 5Y � � � ic."11 C c
Zip Code: _ �'i � Fax: ��ft-
City: ,1i W setr`r! yic r e State: Z-
Phone No.
Zip Coder _ Fax:
E-Mail:
Phone No -77 �t ol 0'
E-Mail�1:A'e-(-
Fill in fee simple Title Holder on next page [ if different
from the Owner listed above)
State or County License -2) I2lc.u'-
it Value or construction is Z5UU or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,00 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTIOR LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE MOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 consuit 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 1 will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The foiiowing 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 your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for owner
/License
STATE OF FLORIDA _. STATE OF FLORID 1
COUNTY OF - LUC k COUNTY OF l _ � -� c I
Swor o (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of : I . tpuC� 2020 by
Name of person making statement.
Personally Known OR Produced Identification ,.
Type of lde<ification
Produced t1_�y
0A
(Signat ire of Notar�r Pub€icij O�,NTHK M. NUTT
My COMMISSION # GG 17791
Commi to No. Qot (Seag "-Jauary22,2M
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REVIEWS I FRONT j ZONING
COUNTER REVIEW
DATE
RECEIVED
COMPLETED
Swor ❑ (or affirmed) and subscribed before me of
�F P ical Presence or Online Notarization
this 4day of 2020 by
Name of person making statement.
Personally Known '�R Produced Identification
Type of Identification
Produced
of No ary ublic
; :YP GYNTHLAM. NUTT
n o. 1 =,: :*• �l155f0A! # GG 1778
�IyRru E$: Jawwtiry �y�yyarr�y211. 2'', 2022BONW �
SUPERVISOR
REVIEW VEGETATION
5 REVIEW MANGROVE