HomeMy WebLinkAboutBuilding Permit Application 7/23/2020 4 : 18 PM FROM: Staples TO: +17724621578 P. 1
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1,Z3-217 Permit Number: 7f-D7)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:
R `PO �"I u T. r , t 7 P•'.�,,X,``.i, i�f tf.YF.
Address: I Q L/i T R i U E 101 J Q j e 0 S on be i F
Property Tax ID#: ,�) 2) T . (oo ) • ® (� 'D� Lot No.
Site Plan Name: ��/ f J Block No. /
Project Name: [A�4lX R kA L.0 V0 VYI L 1 Z / I rCkiS
DETg1L�D`DESCRIPT�t�N OF,111/aRfC,
f R,L O- k [.. C. Q ..
W S l�Cr� dQ 0 VVI
New Electrical Meter Second Electrical Meter
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0 STRU 1 N I FO. M t0N
Additional work to be performed under this permit—check all that apply:
Mechanical Gas Tank —Gas Piping _Shutters _Windows/Doors _Pond
L/Electric _Plumbing _Sprinklers —Generator —Roof Pitch
Total Sq.Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ Q(� ' Utilities: —Sewer _Septic Building Height:
�ONTRA�'C'0
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Name L�MW ! arae: C �-
Address: 0 D 5, CEJ C '�,�Ai L/I P,t IAC b 16ompany: Z_
City h aoitate:EZ Address: l LED [t}— L/ZCA
Zip Code: Fax: 301 City: 07/14e6.C- State:_E/
Phone No. Zip Code: Fax: _
E-Mail: Phone No 7 J 2-7
Fill in fee simple Title Holder on next page(if different E-Mai! J_ j d C L /90
from the Owner listed above) State or County License
If value of constriction is 2500 or more,a RECORDED Notice of Commencement is required.
If value of HAVC is$1,500 or more,a RECORDED Notice of Commencement is required.
7/23/2020 4 : 18 PM FROM: Staples TO: +17724621578 P. 2
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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 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.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 commencing work or recording our Notice of Commence n
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Signature of Owner/Lessee/Contractor as r ne r Signature of Contractor/License Hold
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ��6_ COUNTY OF Sk Lu o .L,
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
�Ph_yjical Presen a tz e Notarization _�hys�'cal Presence o Online Notarization,
th' ay of 2020 th' iay 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 Ide tifrcatio Type of Identificiti n
Produced �oA LProduced
(Signature of Notary - r.nf LlQ,ida6 , (Signature of
;�aV?�e• JEAN RU?=NS D;•NTILUS
i$*` tEAlI RU6FNS OA,�71LO� .- hAY COMKIISS10N# , 87
Commission No. �axcovaublsW F fcj Commission N
a E s.:ca,; �-rr•;ori � r,• ES:October t�,20 t
'' �� AdwAM_ W ir:1 .$ �:• BondedThruNulary Public U. .rt.m
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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