HomeMy WebLinkAboutBuiilding permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Planning and Development Services
Permit Number:
Building Permit Application
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Residential
Address: i2ia�,3 _!� //y >)JAAl Riye,2 1)r,
Property Tax ID #: qs C ` - &oZ ®0f) (0 o 000 - y Lot No.
Site Plan Name: Block No.
Project Name: �41 Af i Z yI>
DETAILED DESCRIPTION OF WORK:
-7-4 A-C- eo r' P & y-I 4'rI N6 t . i t2vot- a ry ;L i_'t t� j 8 &--J 'd _)0G ' 'r 64W 0 0'oe NA C�& W iA
Axor
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 J76 T Pitch
Total Sq. Ft of Construction: 6 _ Sq. Ft. of First Floor:
Cost of Construction: $ 600 . = Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR.
Name Jh4ofv
Name: 60/� UL-12 ` O 5'/IV,/4/
Address: 120&,' 3�IAJNAAI 111� ,'C.
Company:61� WOOPil✓6 %/VC-'
City: '_kw�a; State: '
Zip Code: �W, 7 Fax:
Phone No. rl %2 '.26-� 1i2 -P`7
Address: 389" 5G � �%� L= 15
City: 5`r`/ IK7- State:
Zip Code: 3�Fax:
Phone No '7 94w
E-Mail: It4AL4,t`<_= r'i,/ (2
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail ta�G� (�� Ea'�✓'1ir Gi.t/a%���'
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUGTiON LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: I Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. A Notice of Commencement m e rec rded in the public records of St.
Lucie County and posted on the jobsite before the first insp ion. If y Ttend to obtain financing, consult
with lender oran attorne be#ore commencin work or re ri, our ice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF Mi4im tJ
Sworn to (or affirmed) and subscribed before me of
'�$- Physical Presence or Online Notarization
this _Llt_ day of A-y6u� ,2020 by
Name of person making st4 et'nent.
Personally Known K OR Produced Identification
Type of Identification
Produced 9M11e2 tlaA SG
(Signature
State
Commission No. 6b ?3556$
+Y,,� Nutary Public Stzue of
r Maria Y Cajachayu
h . aG) My commissr: ci G,-
Expires 12101120:: "a
r„ nit
of ContractorAlii6ense Holder
STATE OF FLORIDA '
COUNTYOF HA4,7-j^I
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this _q day of Fh/64VSf• 12020 by
(ovilIwz",0 !'Awr- I
Name of person making statement.
Personally Known Y OR Produced Identification
Type of Identification
Produced Pluyek
of Pd'otary Public- State F!l,da) Notary Public State of F
p �-7 ''�� Maria Y Cajachagua
1 No.GG I�`� d� ', (� CM commission GG 93
�1e, pyres 12/01/2023
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20