HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
11i��o LVULyQ-
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: 'e - boo+
Address: 2 Chris-fenSen 3�d Far pE�(�r, FL `19�i
Property Tax ID#: 3403 ' SQa -01 q2- — DO 2f Lot No.
Site Plan Name: Block No.
Project Name:
- rlart_� shinj9� aD VI-etAl
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit— check all that apply:
_Mechanical _Gas Tank
_ Electric _ Plumbing
Total Sq. Ft of Construction: 6000
Cost of Construction: $ ) f'9 510 ° D U
_Gas Piping
_ Sprinklers
_Shutters Windows/Doors _Pond
Generator T Roof Pitch
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height: I (
Name f a sf 'Powell
Address: q'li�—' &k-1 '1Cn.re,?
City: F—nrJ+ pierce State: FL
Zip Code: 3 49 C I Fax:
Phone No. `1-12 - - q Fr) -- 6111 V%
E-Mail: LlrC.ou✓tisr9Gl$Yae4ae'1-49eorsf'&co,erd'S..ne4
Fill in fee simple Titleholder on next page ( if different
from the Owner listed above)
Name: Dulce S. d..ar-a
Company:T,Df4i ?'-a u ''3h? Hf!41 each
Address: 3NO .SE 70 zr'
City: p qr°$" Stater
Zip Code: 39492 Fax: 7J2, &7Z-9d33
Phone No L1Ip111/7
E-Mail ovnl9 `fh-e e io .41
State or County Lice se r f 3 -d i.�
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.
i
r
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: 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 u Intendbtain financing, consult
with lender or an attornkw before commencing work or le In ur Nbtiye�.nf�'Commencement
of Owner
for Owner
STATE OF FLORIDA STATE OF FL
COUNTY OF 0 a COUNTY OF
(or affirmed) and subscribed before me of
sical Presence or Online Notarization
day of �7 VV ly , 2020 by
of person making statement.
finally Known V__ OR Produced Identification
of Identification
Commission No.
REVIEWS
RECEIVED
. ....
Ivo[ary Punk r5ta[e 0,I ..
e
zd through Nauuna, �=es
FRONT ZONING
COUNTER REVIEW
Sworn-ti5 (or affirmed) and subscribed before me of
_ Physical Presence or _ Online Notarization
this _ day of 2020 by
Name of person making statement'
Personally KnownOR Produced Identification
Type of Identification - ---;�
(SS,igifaturle'of Nota blic- State of Florida )
Commission No. {A 6r I q13io (Seal)
SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW
Please complete the following form and return the ORIGINAL signed and notarized to St.
Lucie County Contractor Licensing Department, along with the checklist below,
LICENSED QUALIFIER NAME
IAX 3_
I r
COMPLETE
HOMEADDRESS
-L SW a ; -
Ppri ' ..l ro --�- 3H9a"3
HOME PHONE
`7 - Z -,i % ()
- q 'I I jp
E-MAILADDRESS
Ar-ao
I- ! k s.
LIA
BUSINESS NAME
-Fo-ra
u06A(, v d n "ike
COMPLETE
BUSINESS ADDRESS
3) 140
-e S+
3q4
BUSINESS PHONE AND FAX
-7 2
'- 44 I (} .- j I J 69
E-MAIL ADDRESS,
G r
ii n Fmk r F . i e
Please make sure that the Business Entity NL e, Workers' Compensation and Liability
insurance, all match the State Certified License.
1. Provide a Certificate of Insurance for Workers' Compensation and General Liability directly from
the insurance Company with the certificate holder's address reflecting as follows:
St. Lucie County Contractor Licensing, 2300 Virginia Avenue, Fort Pierce, FL 34982
2. Provide a copy of the License provided by the Florida Department of Business and Professional
Regulation,
3. A clear copy of the guallfier driver's license
STATE OF FLORIDA
COUNTY OF
The fore Ding instrumen was acknowledged before me this
iy day of 20Z-0 by
Dn! Ce arA' who is
personally known to me or �.as p�duced na loy kn�r)
as identiff -Rn. /' ,/
SAMIHA M. GONZALEZ
Notary Public -Scale of Florida
Bonded (hmugh NA;01 al Notary Asw 1
CHRIS r)?A 70VSKY, DimctNo. t • UNDA BART7, DisriG No. 3-FRANNIE H(JBCIM,13ON, District No.4 • CATHY TOWNSEND, DL*ittNo. 5
2300 Vfrginia Avenue . Fort Pierce, FL. 34SS2-5652' Welosite: w-situoeco.ora
'CONTRACTOR LICENSING: (772) 462d672-` FAX: (772) 462-1148 Enna6: contractor licensfna(ft1ludeco.ora
• CODE ENFORCEMENT: (774 462.1571` INSPECTIONS: (772) 462-2165 PERMITTING AND ZONING: Phone (772) 462-1553 FAX (772) 462-1676