HomeMy WebLinkAboutBuilding permit appAll APPLI BLE IN O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: vF 3 2.0 Permit Number:
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: W Zx�" ^DC�( LS
- . ifEfstlE-Offillk
rr��w:
Address: 'l () S l
Property TaxlDq:��3S—�Ol— ����'—Ob0
Lot No,
Site Plan Name:
Block No.
Project Name:_
I� cV 7j� t�vJt�ou�S W _ Z
S4�i7crZ�
New Electrical Meter Second Electrical Meter
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: Sq. Ft. of First Floor:
Cost of Construction:$ J!C, Cl Utilities: Sewer _Septic Building Height:
Name Name: SQ 7
Address: It oS C= Lam'-) — Company:KW�tgttl R$S
" City: _,4�cW k{j4Evi' State: Address:�� 2 1U!3�
"
Zip Code:1\A(4s7 Fax: City: STur��f
Stater
Phone No. Zip Code:S�I�{C(. Fax:
E -Mail: Phone No �Z'�i0 �
Fill in fee simple Title Holder on next page (if different E -Mail s
t— I
from the Owner listed above) State or County Lice se 'L5%AXl 0
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.
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
,W INFORMATION:
MORTGAGE COMPANY: Not Applicable
Name.
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
_Not Applicable
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.
Inconsideration 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 ins. you intend to obtain financing, consult
with lender or an attorney before commencing work ecordin¢ fur Notice of Commencement.
Rev. s/b/LU
Si n Cure of Ownetf Lessee/Contractor as Agent for OwnerSiineWfeV
ontractor/License Holder
STATE OF FLORIDA -
STATE FLORIDA
COUNTY,OF ; L )ftx�'_
COUNft0Jr
Swor to (or affirmed) and subscribed before me of
Swell,o (or affirmed( and subscribed before me of
Physical Presen a or Online Notarization
Physical Presence or Online Notarization
this dayof ,2020 by
thiT2.:3day of 1; .2020 by
Na a of person statement.
Name of pEkson making state
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of ]den �tificati�-on
Type of Identification
Produced L+L(.yX SJ
Produced
J
%7> '
( nature of otary Public
State.of.florid§a,y 10ANE9EFoaDE
(Signature of tart' Publ -$ "' Flon kOANESEFosDE
NOnry Wok-StateMGbrida
Notary WW¢- SMleaf rbrba
Commission No.
-, (SIDaro'�:FaN.ccrnsans
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Commission No. ' rQ�6ea6j.cs n9ass
-`.�'� MYComm.Fprer Au939.3021
- .`�_'`MYComm.Gmres Au9292931
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. s/b/LU