HomeMy WebLinkAboutPermit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _2ZI 2Z20 2-0 Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial V/ Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address:
PropertyTax ID #: ° 555--" (oCt - 00c)0- �f(ws'- , Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:'
_ v
L'�M c-, --n C, —11
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 _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ , 1.=p t r, c _ % Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name T h c A t rsn W 0c,
(�'� n ,� a` �� � � �.. "(il-i'",Z
Name: V
Address: 2'(` CC Y° rr`
Company:
City: if-viseki beteg: k State:
Zip Code: 1i 64 1, I Fax:
Phone No.0 `j
Address:il QK)I,
city:1 X) ?" tt�� State: Y L
Zip Code: 3 3 a. 1L_- :I— Fax: �rvG(_ !'---;-3-- -7-3
Phone No x;61- �S'ili
E -Mail: Glc vts�e�� 5 �!s �_�`ltSt,tieT
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail A Vo & cr�� (Z,�- -y)�� 'AL --
State or County License ci<�c� 1 7— q 2 I
IT vaiue or construction is zbuu or more, a KECURDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
M1
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:c= _-�, ��lam, ;-yl , -'X (
Address:2cR ) (, C ,a�� - (��1.
City: S—, L5 A R -T State: T L
Zip:_a k ct '� �f Phone -MZ
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: -_
City: t State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City-
Zip: Phone:
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 thepermit 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_attorne bef re commencingwork or recordingour Notice of Commencement.
Signature Ow°>rier/ Lessee/Contractor as Agent for Owner Signature of Contractor/License —....
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF `?c, i.._
Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
py5ical Presepce or Online Notarizationµ`'Ph r i�al Presence or Online Notarization
this day of �4 2020 by this day of t} a u,, 2020 by
An n t CCName of person making statement. Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produrd
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- St e:,,gCQprida) LISA SIERRA i nature Notary
i� ;:° — % Notary Public - State of Flori a g y Public- S to of Florida )
Commission No. (� I �;�� 4�mmission N HH 002979 ,nrrr rr
4 ''� "O`'`( Ebmin. Expires Aug 31, 2014 mmission N ,+ =';t•'°•
.. of f�,.• si-�Sf
Bonded through National Notary As n. g ;R. I
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION S FURTLE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
RTA C,".LAZO
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REVIEW