HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMrL i ED FOR APPLICATION TO BE ACCEPTED ._ `9
Date: % 1 a Permit Number: aa6Q--6a51
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Planning and Development Services
Building Permit Application
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial X—
JUL 13 2020
Lucie
PERMIT APPLICATION FOR: \
PRCiPOSEDJMPIROVVEq T,LOCATION..;
Address:
Property Tax ID #:
Site Plan Name:
- I U L) VUt zJ - OW / Lot No.
Project Name: AA M&{Z AIR R0 t 1±46 09fJP0
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New Electrical Meter Second Electrical Meter
Block No.
;CONSTR, UCTION;INFORIVIATION;, ..: "'�
Additional work to be performed under this permit- check all that apply:
Kilechanical
Electric
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
_ Gas Piping
_ Sprinklers
Cost of Construction: $ /L$ ODO. —(y
_Shutters _ Windows/Doors _ Pond
_ Generator
Sq. Ft. of First Floor:
Roof Pitch
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE., _.
CONTRACTOR r, a '
Name M 1 anA441z Rog%qL.6Name:
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Address:
I
Company�%ih
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City:;,Z]@V5dnV C]c—aCh
Zip Code: 34 4S 7 Fax:
Phone No. 772 - Z y — bZ
State:,
85-
Address:7/69 S1k/42—TER
City: M Ir-7'm I
Zip Code: 3 3 j 55 Fax:
Phone No 3oS- 662 - 7777
State:
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail R LOpEZ C�T�T'j 11�71e�L
PQ t; .GON�t
State or County License GrM L. O /V73
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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.
��UP�>�LE�IV)ErNTAL CONST�U'CTrI tLl( IEN ILgW,I'�IFO,R'
ATI r'NI ` � _ °
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DESIGNER/ENGINEER: _
Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
_
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _
Not Applicable
BONDING COMPANY:
Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: el 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_corn mencin work or recording our Notice of Commencement.
__?/L z� 'e4v Z
Sign ure of Owner/ Les ee/Contractor EAgent for Owner
—
Signatur of C tr se Hold
STATE OF FLORIDA
STATE OF FLORID
ZAI-Dkej>t
COUNTYOFVT•LLCG,4
COUNTY OF Mb
Swornto (or affirmed) and subscribed before me of
Swom to (or affirmed) and subscribed before me of
V
Physical Presence Online Notarization
Pj�ysical Presence pr Online Notarization
this-'7 day of vT 2020 by
this � day of O 1 2020 by
Name of person making statement.
Name of person making statement.
Personally Known _Z OR Produced Identification
Personally Known ✓ OR Produced Identification
Type of Identification
Type of Identification
Produced
Producced
(Signature of Notary Public- State of Florida)
ef
(Signature of Notary Pu egpfm�1 fdtJa o
.A 'i My Commission GG 105801
Commission No. VFANCIsgidDT
21blic
Commission No. OS / �i Expires /1W 021
Notary-state or Flodda
•' Commissim#GG70212
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