HomeMy WebLinkAboutHOLT PERMIT UPDATEAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date Zr Permit Number:
O
" ftn-- A
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial Residential V
PERMIT APPLICATION FOR:
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F'1C�11EIPRL7MEIT LQCTIC7N; -
Address:. Q9 I ()_ -S n fA r Li 1 i_. C1l i
Property Tax ID#: -.--
Site Plan Name: JUVchtinncn C�
Project Name: _
..}�#pTiC�N OF 111/C3RK.
._ -r I le -CA �-i C LAC, s� ��
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit -check all that apply:
—Mechanical
_ Electric
Gas Tank
2plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ -Sd 0
Gas Piping
__.. Sprinklers
Lot No.
Block No.
Shutters Windows/Doors Pond
— Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
Name I 4-4i -
Address: 1 ,� >♦_
City:
Zip Code:'' Fax:
--
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
RACTOR:
Name: e- Y { cf-
u GS4
Company: r
Address: a
City:,. S Oa State: V L
Zip Code: 3q Sq LA Fax:
Phone No
E-Mail t
State or County License C Y(-l"2-- 1)
If value of construction is 2500 or more, a RECORDED Notice of Commencement Is required.
If value of HAVC Is $7,SO0 or more, a RECORDED Notice of Commencement is required.
f SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable -
Name:_
Address:
City: State:
Zip: Phone
MORTGAGE COMPANY: Not
Name:
Address: ,.....
City
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY:
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
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 subjiett f,;,, f4,','
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict '
structure, Please consult with your Home Owners Association and review your deed for any restrictions which may
In consideration of the granting of this requested permit, 1 do hereby agree that I will, in ail respects, perform the
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 -reside,.
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice;
improvements to your property. A Notice of Commencement must be recorded in the publ,;;; f::
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain fir i, r#*
with lender or an attorney before commencing work or recording our Notice of Commenclra��.x
Signature of ner/ Lessee/Contractor as Agent for Owner Signature —ofContfac-tGP/606rise
STATE OF FLORIDA C11 STATE OF FLORIDAP _
COUNTY OF� ) �. 1 COUNTY OF
Swor to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before mkt of
Ph sical Presence or Online Notarization Physical Presence or Online Notariig; ,five
this � da of 2020 by this hl��day of� L 2020 bV
Name of person Fnaging s atament. Name of person making statemen
Personally Known 1/
Produced ldentificati
Personally Known OR Produced Identi of t
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Pu
t. %� �rr�ICY7l-ETTr
14i�' COM ISSION # GG 367040
(Si atu f Notary PR
Notary u I c - Sta
of FloralD25
No.
Gammission # GCommission
Mycomi(r &O)res
Commission No.gusi18,2023
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE yi4.F,; ";'. 0,111
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED