HomeMy WebLinkAboutPalmentier Building Permit Application 8 4 2020All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: g i4 Za Permit Number:
o
' 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: 1 \oe,4 ti �L �( x. v►-, ,,k. e,✓
I PROPOSED IMPROVEMENT LOCATION:
Address: 5103 b'ra'e n L -in T—L,
Property Tax ID #:
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
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
Electric Plumbing Sprinklers
Total Sq. Ft of Construction:
�t
Cost of Construction: $
Generator
Sq. Ft. of First Floor:
Iam 9rel
Block No.
-Windows/Doors _ Pond
Roof Pitch
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name mo¢. - Mn'a.r..i.,'t"e
Address: 5 10
City: =/fir r �v'GF✓ State: Eli
Zip Code: 349 <1 Fax:
Phone No.
Name: f * 4T_�s
LC -
Address:_ 0'1"k i eN
City:..a t� 9c.-c.A_- -- - _ ----- State:){,
Zip Code: 3Q9 & 3 Fax:
Phone No
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail Ca
State or County License 171__LE-C-130 012 t
It 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:
Address:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: Not 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.
1 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.
0: � 4� e � 4 � L2::� 14 �
QL=9_a__tJ_
-
Signature of caner/ Lessee/Contractor as Agent for Owner
-
Signature gftontractoi.License Hold
STATE OF FLORIDA
STATE OF FLOFJIDA
COUNTY OF
COUNTY OF Val
Sworn to (or affirmed) and subscribed before me of
Svu� to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
�" P sical Pres nce or Online Notarization
this day of 2020 by
thisday of 2020 by
Name of of person making statement.
Name of personakinggstatement.
Personally Known OR Produced Identification
Personally Known ` OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
V J&i, —y , C
(Signature of dtary Public- State ofMY COMMISSION #GG2
(Signature of Notary Public- State of Florida }
Commission No. (Seal)
EKPIRES. AUG 19, 2q
Commission No.,r � S Oa a*dedthmughlstStateins
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE i
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. blb/z0