HomeMy WebLinkAboutApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l'A:=\ _ Permit Number: a.a01 _o1d0
- Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Reside
-2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Property Tax I D #:
Site Plan Name:
Project Name:
n�y6 -j-,-soy,-'d\ \I - dao -
New electrical Meter Second Electrical Meter
Additional work to be performed under this permit—check all that apply:
RECEIVED
JUL 2 9 2020
ST. Lucie County, Permitting
n la
Lot No.
Block No.
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors _Pond
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction _ Sq. Ft. of First Floor:
Cost of Construction: $ t ®�j� j QO iJ Utilities: _ Sewer _ Septic Building Height:
Name_5�, Liln�� (moi
Address: 7 ea,o (/i r.: 'gip,Fg ✓H
City: /�� Pz� c r State:
Zip Code: J �V $ g ,2 Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
City: Pt C rd C State:�li
Zip Code: 7,41 . Fax: w�
Phone No ' 7 • c( ^ I n — ql a s
E -Mail
State or County License�x�wt
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.
DESIGNER/ENGINEER:
— Not Applicable MORTGAGE COMPANY:
Not Applicable
Name:
Name:
COUNTY OF
Address:
Address:
Sworn to (or affirmed) and subscribed before me of
City:
State: City:
State:
Zip: Phone
Zip: Phone:
\day
Name of person making statement.
FEE SIMPLE TITLEHOLDER:
_ Not Applicable BONDING COMPANY:
_Not Applicable
Name:
Name:
Produced
Address:
Address:
(Signature of NotaH P I ` ,of FVLq IISSIONg 66 D2`2023
City:
City:
Commission No.' (Seal)
Zip: Phone:
Zip: Phone:
REVIEWS
FRONT
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and mstauation as maicateo.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Countmakes no representation that Is granting apermit will authorize the permit holderto build the subject structure
which is in co 1xict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consultwith 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, swimmingpools, 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 Ipnrlor nr an attnrnpv hpfnre rnmmencine work or recordine your Notice of Commencement.
RM S/b/ZU
Si a y e o actor License Holde�,'�.,( vias.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF S�. Lvl�%�
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
- Physical Presence or Online Notarization
Physical Presence or - Online Notarization
this _ d"ay of 20_ by
this _, of t1 �j� 20aa c) by
\day
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 Identification
`T
Produced
Produced
(Signature of Notary. Public -State of Florida)
(Signature of NotaH P I ` ,of FVLq IISSIONg 66 D2`2023
FjpIRES:DecsMbsr13,202D
Commission No.' (Seal)
Commission No. Bonded ryia U"der�Aten
REVIEWS
FRONT
ZONING,
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
RM S/b/ZU