HomeMy WebLinkAboutAPPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: f5 - __5 - 2-C Permit Number:
Building Permit Application
Planning And Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Residential R.
PERMIT APPLICATION FOR: ctr�C�C,C3c_l1C'�r `� rE'_StC�X1C
PROPOSED IMPROVEMENT LOCATION:
Address: S.
Property Tax I D #: 2�J Lot No.
Site Plan Name:
Project Name: Czi a kK1) ilM_1� 1
DETAILED DESCRIPTION OF WORK:
New Electrical Meter ''l Second Electrical Meter
CONSTRUCTION INFORMATION:
: Meq, MM
Additional work to be performed under this permit- check all that apply:
'Mechanical , Gas Tank —Gas Piping _ Shutters _ Windows/Doors Pond
Electric 'Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction:
Generator ✓"Roof 0.1 5 Pitchl
Sq. Ft. of First Floor: �k �Q J } i�� +A"lL.
, t+
Utilities: —Sewer _Septic Building Height: I U I
OWNER/LESSEE:
CONTRACTOR:
Name CA
Name:
�►�
Address: '350 QW '34 -JL' `_- -f .
Company: FOLC2_ 2-0
\0C,
City: \J\j `, 1 -f�'tu- n State: FL
Zip Code. 24-0' 0 1(_ Fax:
Phone No.1�'- -ca'34 -.0 c���
Addre( s: 4r4 rD I'J \NJ 9V-\ r,F
City: 1E � f LJ k_U4_
Zip Code: �'� q 3 Fax:
Phone No I 7v�' 3' '�c$
i✓; \41��
State: R-
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail Uarf) , i-) 6) l't.C,r`-CW0)h0
nXS.0
State or County License
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: _ Not Applicable
Name: j_SQ10h mr-Carw
MORTGAGE COMPANY:
Name:
Addre 15-1 Si
City: I r !Sk�te__
Zip:. 9SLo Phone: -sic]
Not Applicable
e_ - 71
State: _-_
-'3()—1 — 01(-`)
Address: q6� 5C
City: t State: CC_ i
Zip: Phone _- 7-6q3�
FEE SIMPLE TITLE HOLDER: mot Applicable
Name:
BONDING COMPANY:
Name:J°
�. of Applicable
Address:
City:
Zip: Phone:
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 lender or an attorney before commencing work or recording vour Notice of Commencement.
Signature of-Cer/ Lessee/Contractor as Agent for Owner Sig an tore of Contractor/License
STATE OF FLORIDA, STATE OF FLORID,
COUNTY OF .r_Lr C �., COUNTY OF ✓ k C
Sworn to (or affirmed) and subscribed before me of
Physical Presgnce or Online Notarization
this <5 day of /-\-( 2020 by
Lys r'ea) ,_(o d (r r)
Name of person making statement.
Personally Known � OR Produced Identification
Type of Identification
Prooced
El
(Signature of Notary Pu ic- State of Paula S. Br#l(
Commission i# G(-
Commission
{Commission No. _ ea% Expires: September'
Banded thru Aarar
_., OF
REVIEWS FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Sworn to (or affirmed) and subscribed before me of
X Physical Presence or Online Notarization
this day of 2020 by
_ Are("-) �Jad(vi n
Name of person makingstatement.
/
Personally Known �° OR Produced Identification
Type of Identification
Produced
fSi nature of Notary P lic- State of Florida )
)3D83 ,�` `4" „�,,, Paula S. Breier
mission No. �'r - CamOi 11 I GG030843
Notary Expires: September 15, 2020
SUPERVISOR I PLANS I VEGETATION SEATURTLE I MANGROVE
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