HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
SM dCII( LC 77
..
0, J .........Y
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:
�N POSED IMPROVEMENT LOCATION:
Address: c1(e5 S OCf4rj Dpl _ UNi T aooy
Property Tax ID 4: 450=- "4110 -018M-0M=1 Lot No.
Site Plan Name: -flkE r'X1wESS Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
WE VVILL IKSWWw A N&J CVA& AND Sh yyjCR. PAN t.y.,y2 sN Iiie Gu£sitM�7LTi2 $g�}IGoorlS Ca<fq�cE w+' 7N�
S)JeWIC& V41,vL1 ^ND CALA� i..j fnrt owe -8p our /niSPCcrforl NE 1JJLL Cots; &" Aop WSMLL- 771E Slok+%Z
'Tit,,% i NGJ -M'Lfl' AdD a NEN FAurAB IN 711E MAsrEe &1}1 AN3 CAU, Im4 flN*(e / 1VS ECOTov"
New Electrical Meter Second Electrical Meter
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
Mechanical
Electric
_ Gas Tank
Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ S), 52,010
Gas Piping
Sprinklers
Shutters _ Windows/Doors _ Pond
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
j OWNER/LESSEE:
_---- _----- -_----_-_.__--
CONTRACTOR:
Name I AIZA &t-c-ZDA
Name:_CHk13 RoG,CAS
Address: C( S.Oc.EAj DX. UNIT 2404
Company: o6p,* pI,UL'
Address: V71 .SUI (4tA**zSf L'g
City: 1?S.L, State: FL
Zip Code: 3YU3 Fax:
Phone No 940. 1144
City: .EMKO RC40A _ State: J��,
Zip Code: 344x7 Fax:
Phone No. 154 $V -$-j)
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail -hi AelSoA $Io ", •C*-%
State or County License C.FCf* 1`{;4y6;1
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.
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DESIGNER/ENGINEER:V 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 you intend to obtain financing, consult
with lender or an attorney before commencing work or recording your Notice of Commencement.
Rev. 5/5/20
"
Signature of Contr for/License Holder
Signature of Own / Lessee/Contractor as Agent for Owner
STATE
& �
STATE
a
COUNTOY OFORIDA
ude-
COUNTOY OFORIDA
Sworn to (or affirmed) and subscribed
before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or
Online Notarization
Physical Prese ce Qr Online Notarization
this today of (
2020 by
this day of (.�l 2020 by
Gn.yis Ill as
Cervi s I�q>�s
Name of person making state ent.
Name of person making statement.
Personally Known X OR Produced Identification
Personally Known X OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Nota Public State
(Signature of Notary Public- STm2t
O
ignature of Notary Public- St e o dIRACY CARVALHO
+J Commission GG
50192
jRI�I 950192
�1p a Expires 03/22/2024
Commission No.
mmission No.
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Rev. 5/5/20