HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INfO MU$T BE COMPLETED,f_ORAPPLICATION-TO'BE_ACCEPTED- aa��
.Date �"/ `�C '� Permit,Nucnber:. ..ol 0 � .
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Building`Permit Application
PIo"nriing and DeVelop►nent'Senices
Building and CodeRegulatwnDivision Gotni1let al, Residential
2300'Virginia Avenue,•Fori Pier[e,FL.J4982
Phone:.(7721462=1553 Fax:(772)4624578 {
PERMIT APPLICATION FOR:
(hof ),irn 4c, L. C r b- - -4ynC e
1 .PROPOSED.,IMPROVEMENT LOCATION;
Address: -T- a {e:LL e."y�r• Ar U e,. t r�I' r e v 't- L S71
Property Tax ID&I ��3 ID Q A_6n r)-. !q, 16f No.
Site Plan-Name: r Block'No. i
Project Name: YtC
DETAILED DESCRIPTION .OF UUORK I
�r. SSu.r-�
o t,
New Electrical Meter Second Electrical Meter'
CONSTRUCTION INFORMATION:
Additional work-to be performed 'pnderthis permit.:check all that apply:
_Mechanical, Gas Tank _Gas Piping _Shutters _Windows/boors. Pond
_,Electric _Plumbing _Sprinklers Generator _Ro_of Pitch
Total Sq. Ft of Construcfiori:,_ . • �- . Sq.,Ft.,:of First Floor: 1
Cost of Construction:$ -�% coo,o. 1Jtilitiesc .Sewer, _;Septic" Building Height:
OWNERAESSEL :CONTRACTOR:
Name: (70rn1V\ C_ .Name:
Address: -rUQ-3 be,�I tea, �y .,. I
_ Company:
City: ror� ire:►cog State:,F'L_ Address:
Zip':Code:- 3 "q Fax:- city., _State:
Phone No:=(-77Xqjqy b 88 Zip Coder Fax;
E-Mail: CCL Irco rt8 r6-A CiroJt_2t . in_ ,C sST tic* Phone No
Fill infee simple T'itie`Holder on nett page(,ifdifferent E-Mail i
" from the Ownerlisted above) State or County License.
I
If value of construction is 2500 or,niore,a RECORDED Notice'of�ommencemeret m.required.`
s.r.:...,s aiwa�r=..•to cnn..�,........ '.:.ocnnonrn s::.r:�..s r......,................�:.... ..:....i
SUPPLEMENTAL CONSTRUCTt0PI LEEN' LAW INI=ORMATIOlV
DESIGNER/ENGINEER:- _Not_�AppIkAble MORTGAGE COMPANY: _ No_ t-°Applicable
Name; Name:
Address• c _
es
City State City:: State. i
Phone ,Zip: Phone: _ I
FEE SIftAPLETI, HOLDER: Not�Applicatile BONDING COMPANY:, _Not Applicable
:Name: — Nam'e:_ _
Address: Address;• {
City;
city-
Zi p Phone: Zip P,hnne:
WNER/CONTRACTOR AFFIDVlt:"Application Is_hefeby madetobbtain a permit to do:therwork-and iinstallation-as indicated.
I-certify that no work or installation.has commenced•prior;to the:issuance of a permit. j
St.'Lude.Count�yy makes no representation that is granting a permit'wdl authorize thp�O ermit holder to build the subject_stiucture'
which Is_inc6nflict with any applicable Home Owners Association rules,;bylaws or and covenants`fhat may:restncf_or prohibit such-
structdnL Please consult with your Home Owners Association and review yourAdeed for any restrictions which.mayapply. _
In consideration of the.granting of'this,re. queste.d permit,l do'.hereby:agree that 1-wiliji-i all respecis,perform the work
in accordance with:the approved..plans,.ihe Florida.Building'C.odes and.St:.Lucie County Amendments..
The following building'permit`applications are exempt from under oin a full concurrency g g cyreview:,room.additions,.
accessory•structure's,.suv7_mming pools,fences,walls,signs,screen:rooinsand accessory uses to;anothernon-�esid' — I use
WARNING TO OWNER:Ynur failure'to Recoid''a Notice ofCommencement may result in paying twice'for
improvements,to your property.A Notice of Commen'cemenf:inust be recorded to the public records of`St:
'Lucie County and posted o the-- bsi"' "before the first;'inspection If you inten.'d1p ' tain financing;;consult;
with lender or,an a n efore commenting work'or record' our Notice; o mencernerit:`
Signaii.Ve of.Owrier./ essee/ ontractor as Agent'for Owner Signature Contractor/Lic nse Holder I
` - I
;STATE OF FLORIDA .STATE OF FLORIDA
`COUNTY'OF Si / ��( �✓ COUNTY OF _4,p�rT lc � 1
Sworn to(or affirmed)and subscribed before me-of 'Sworn to(or affirmed)and subscribed before me-of'
Physical Presence or Online Notarization• _X_Physical Presence or Online Notarization
this_day of A:u o u. T. , .3020 by this, ),1 . day of# u.ST .2020 by
- I
Name of person making ateme t. Name 6 ersoi making statem�11 e��nt.
f Yti l CG q i.t Y t7M K1 C�1""(;i"C7
Cs%il• 11!11 G:. I
Personally Known.. x QR Produced)dentification _ Personally Known. }�-_.O.R.:Produced Identification
Typ&oiidentification Type,of Identification
Produced- Produced
,(Sig tur of ary Public-St (Sign of 't ry Pub
`"' STEPHEN P.IAAS, �. " STEPH��I P HAAS
Commission fob. ON#GG975(l0.
1 I-. . - "commission o: c" Qi»�g13:G&5720
d EXPIR�s:lv11iy22,=4 MY Ob
- oP E?�PIRE3t•Msy22.:2024,
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REVIEWS` FRONT ZONING SUPERVISOR" 'PLANS VEGETATION_ SEATURTLt MANGROVE.
COUNTER -REVIEW REVIEW'. REVIEW REVIEW' REVIEW REVIEW
'DATE
RECEIVED I
DATE
COMPLETED
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