HomeMy WebLinkAbout Building Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 2
Date: Permit Number: ,Z06)7 05&Z
9 ° a.p ;°._ 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:
PROPOSED,IMPROVEMENT LOCATION:
Address: 11 EL QA�e.YL_,��y
Property Tax ID#: -(y 0OD- Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
0U
New Electrical Meter Second Electrical Meter
"CONSTRUCTION INFORMATION:
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _ Pond
_Electric _Plumbing _Sprinklers _Generator I/ Roof Pitch
Total Sq. Ft of Construction: off Sq. Ft. of First Floor:
Cost of Construction: $ !!Z,000 Utilities: _Sewer _Septic Building Height: I lof
OWNER/LESSEE: CONTRACTOR:
Name r) U/00 Name: )t(cs gz5�O'L'a -a.-
Address: ?99 ?u Pr i.tJ l'VLe A r Company: A
City: atlu State: L Address:,2t4KJ S E A"t FQulA
Zip Code: O Fax: City:_�o�S A `,UC; Q Stater
Phone No. Zip Code: _ Q!K Fax:
E-Mail: Phone No 741- 501— 7ro 33
Fill in fee simple Title Holder on next page(if different E-Mailer
from the Owner listed above) State or County License CCC(_ 3149 0
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
SUPP'LEMENTAL:CONSTR,UCTION LIEN ,LAW INFORMATION:
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.ILucie 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
striucture. 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
w' h lender or an attorney before commencing work or recording our Notice of Commencement.
i
t re of Owner/Lessee/Contractor as Agent for Owner a of Contractor/License Holder
S ATE OF FLORIDA STATE OF FLOo A C`�
COUNTY OFaie� COUNTY OF
i
�W QO
Sworn to(or affirmed)and subscribed before me of Swor to(or affirmed)and subscribed before me of
Physical Prese a or Online Notarization Ph ical Prese ce or Online Notarization
thi o� day of 2020 by this _ay of U 2020 by
A 'ft �US4amu�n�e.
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Idenitifi ati r`
Pr uced Produce U
•y' , MAGALI BUSTAMANTE
;_=: Commisslon#GG 339487
( na ure of Notary Pu 'c-State of F da ) (Signature of Not r Public- a ra $may '
G Il o. Thtu Troy Fain Insurence 800 0
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Commission No. emission No. C7 cly/(i� (Seal)
LASHAHNA INGRAM-RAHMIN
my col MISSION#i GG 27506
EXPIRES:December 20,202
REVIEWS FRONT ZONINGnded a� tars NS VEGETATION SEA TURTLE MANGROVE
COUNTER ft—E' V REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 5/6/20