HomeMy WebLinkAboutBuilding permit app All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED n-f- )tfo
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Date: j� Permit Number:
97.ILUCHS
0
Q a a o p = 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:
PROPOSED IMPROVEMENT LOCATION:
Address: o5t) S oce-u.%. DC r�51e.,-S� 6&.CW
V
Property Tax ID#: 14 ,9 a'" �(� L(r p�251 MOLT Lot No.
Site Plan Name: Block No.
Project Name: Cbt\ c7 �eMp
DETAILED DESCRIPTION OF WORK:
Demo in 1aj. 1f(,'� . �rloOc�R� (`t°i�►Q' �4I"tIRoCS 51�ww0'S.
1wft &'0 40 S+1w4'S,,,11 rDr10ontAf5 `MAN &rz Aoc a,.y 5%rC
New Electrical Meter Second Electrical Meter nY'� d�i>,i"l• `� of�f '
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 aj Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 7�OSe 0f.d GOn 70Je?2. Name: Gvr,. ILMp.-
9c,Address: 5 D S D CP,an. 0(- tnfi l5 y ex Company: tti u► m-C
City: 7XAst,.. State:�L Address: 7oc�, S s+ A-D
Zip Code: 15L-1 T57 Fax: City: go-Q(ec - Stater
Phone No. ?n� 2ft- tv q(0 LO Zip Code: _M4 1') Fax:
E-Mail: M 2u^. 2 1 C Phone No 77`l�3
Fill in fee simple tliltle Holder on next page(if different E-MailreyCap�j,p��(istllnDd►(�efAn.
from the Owner listed above) State or County License
If value of construction is 2500 br more,a RECORDED Notice of Commencement is required.
If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
I, i,
i
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: I _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: 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 lerift or an attorney before commencing work or recording our 19otice of Commencement.
ignature Owner/Lessee/Contractor as Agent for Owner Signa i.i of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presence or Online Notarization Physical Presence or Online Notarization
this day of 2020 by this ) day of 2020 by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificatio Type of Identification
Produced Produced
(Signature of Notary Publ - ate of Florida) Si nature of t 'pd�i�,lic-Sta U G H N
ar° ;State of Florida-Notary Public
Commission No. .`` YP�e.,�SeaI�LLEN VAU.GH ission N a 4 Commission # �I�o079
tate of Florida-Notary uD' ,�� i—��r Commission Expires
:• *= Commission # GG 270 79 '���+++` October 22, 2022
°'�°ii;�`� October 22 202
REVIEWS FRONT - S VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.