HomeMy WebLinkAboutBuilding Permit Application From 1.877.233.3839 Mon Jul 20 13:57:16 2020 PDT Page 2 of 3
All APPLICABLE 111W MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: .J• - Permit Number:
Or
"ll ts' Building Permit Application
Planning and DevelopmentServices
Building and Code Regulation Division Commercial Residential i
2300 Virginia Avenue,Fort Pierre Ft 34982
Phone:(772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR:
77—PROPOSED,IMPROVEMENTLOCAT101V
Address: Lt. Q.o- „ 3`
Property'raxlD#: �D� lJ —� �� Doc--)— Lot No.
Site Plan Name: Block No-
Project Name:
DETAILS 'DESCRIPTIOi�f OF WORK W!
F]
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723t llG� ILit.6-1( 7 g/I Ak[ rr L Vl/l O J e U vm Q
Ala 150- -1 +z e
New Electrical Meter C/ Second Ele rical Meter
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.CQ�IS�'RI.ICTION;I.NFORMAT401V ...� � �, .. r,�`; r,�,;. ,. �t ;1•i: s :�•� it � ct
Additional work to be performed under this permit–check ail that apply:
_Mechanical _Gas Tank `Gas Piping _Shutters —Windows/Doors _Pond
LZ/Electrlc _Plumbing _Sprinklers _Generator _,Roof Pitch
Total Sq.Ft of Construction: Sq.Ft.of First Floor.
Cost of Construction:$ . Utilities: _Sewer Septic Building Height:
C±W,Ni:R/LESSCE< C6N17RACTbR
Name f` P R ! Name: 4-Q.,
Address: ro S E Ii!!/1 Company:
City:�nv–+ T 1 'Lt�� Stater Address: �.'3/ RLl+l- F j<.c _
__
Zip Code: Fax: City: 6W FY Stater/r
Phone No.?7��' ��� Zip Code: 3 3�: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail 4,
from the Owner listed above) State or County License
If value of construction is 250D 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.
7/23/2020 4 :22 PM FROM: Staples TO: +17724621578 P; 1
�U{PP��MENT�>�`�QNSfi��U�;Fj�N ��EN LAW,tjyE'pR�t11AT1{4N, ,' , � s
DESIGNER/ENGINEER: __Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _Not Applicable BONDING COMPANY: —Not Applicable
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 installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucia 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 commenci.Dng work or recording our Notice of Commencement.
A11, 41
Signature of Owner/Lessee/Contractor as Ag _0 Signature of Contractor/License Holder -
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF -54- tl_�E COUNTY OF _;C�* ! t t
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
_�hys l Presence or Online Notari ion _�/1'hysical Presence or Online Notarization
thi ay of _ 202 y thi ay of 2020 by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification^�
Type of Identificatio Type of Ide ificati n
Produced Produced
(Signature of Nota ublic-State of Florid (Signature of N P
-_(.aaar:�rmam*ora r' a
"MRUC?FNS LUSIEAN RUSENS NTI US
Commission 9ISSION r - Commission No. h
EXPIRES:October 11,2021c� EXPIRES:C,-:Iete 'i, •..'1 ;
.�-^`rmoa._ "�. -�cw.-. _"":..ip•.«enn�:.e�..r;;pari.. -w....
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.