HomeMy WebLinkAboutBldg PermitAE APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date. Permit Number:
-� LLLC
V
L is tz T Building Permit Application
Planning and Development Services _
Building and Code Regulation Division Commercial I Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: /fer)6e,
PROPOSED IMPROVEMENT LOCATION:
`�
Address: 17 r /`y] �f /C S J �.
PropertyTax ID #: ,2 � �'��y ® 0 ��� Lot No.
Site Plan Name: S ►1 .5 j " !� Block No. `1
Project Name:
DETAILED DESCRIPTION OF WORK:
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New Electrical MeterSecond Electrical Meter j �-
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 Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ �QQ. Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Address: 3712 _5- ;J7 ,��ri�S Gl /'
Company:
City: fo r r 1-�9)"e-'rLe— State:
Address:
City: State:
Zip Code: _�( `J T.Z Fax:
Phone No. Z 2L— o — % %y 7
Zip Code: Fax:
E-Mail: 5/0 �AAooF
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail
State or County License
from the Owner listed above)
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_
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:_
Address:
City:
Zip:
Phone
Not Applicable
State:
FEE SIMPLE TITLE HOLDER: _�ot Applicable
Name:_
Address:
City:
Zip:
Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:_
VNot Applicable
State:
BONDING COMPANY: _,k<ot Applicable
Name:_
Address:
City:
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 lendej or an attocnqy before commencing work or recordin our Notice of Commencement.
SignatuX of Owner/ Lessee/Contractor as Agent for Owner Signat e o Contractor/License Holder
STATE OF FLORIDA ±
COUNTY OF s4c1 'NI 1 Able-- / e—
Sworn to (or affirmed) and subscribed before me of
P sical Presence or Online Notarization
this '' day of , 2020 by
t�, vv�_V I I ICY
Name of person making statement.
Personally Known OR Produced Identification
Type of Iden}fication
Produced n- IN— 1\AL 40g0-_7k'0
(Signature of Notary Public lorb(k8RAHAMORGANTI
* i mi Sion # GG 111620
Commission No. >sJune 19,2021
4
7fFpfa4� Bonded Thru Budget Notary Services
STATE OF FLORIDA,,
COUNTY OF � Lc.( n%
Sworn to (or affirmed) and subscribed before me of
-,"'PWical Presence or Online Notarization
this � day of 2020 by
Name df-pbrson making statement.
Personally Known
OR Produced Identification Y
Type of Identification
Produced t'� t--
("4 �. i �+ 71 3&S
M4(po 414, -713(�So
(Signature of N tary Public
tate o$ftf*�MORGANTI
Commission No.
Commissi%�"n # G� 111620
_ E#ire7 4§�e4,2p21
9,11?oed U- ; . '-.it Notary Services
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED