HomeMy WebLinkAboutBuilding Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
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: R_9_-P
PROPOSED IMPROVEMENT LOCATION:
Address: (.COi2_ Si `Vcy- (.>L2,y, -Cr
Property Tax ID #: 3402_- (t 4 -01 44 , 0QQ, - - Lot No.
Site Plan Name: I Block No.
H-0--Project Name: _� Man • � (-o
DETAILED DESCRIPTION OF WORK: _Q ovsfai:.il 4+250 rn -,'Vk -b
- .11 aw e & 01tmV% c (n -A%s wdii + ( -6 Lode i.I•h
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 oof Pitch
Total Sq. Ft of Construction: Loa-6
Cost of Construction: $ I 'S, () Co
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER LESSEE:
CONTRACTOR:
Name ' :3
s , p cr
Name:
Company: vYL&cL C-0c `4c,1
, `` , �y
Address:(OQ(?- �5(kQZ)J i.e�ti_"Fy•
ii
City: V_(`�r� JPtC_y C.(-, State: t_1
Zip Code: 24gg2 Fax:
Address: Is, S j NIk.VY-u- C rGtf,
City: -Pbrf U,Lc_tG, State: V
Phone No. __N2- 2OC�i e)?_J
Zip Code: 3-1cl �5 2 Fax: 1V
E-Mail:
Phone Not 1P21- (y2(Q gj
E-Mail NA- Ce Q9. -Accs 1tG , cory,
Fill in fee simple Title Holder on next page ( if different
State or County License Cc_� i -3µ3 12_ _4_
from the Owner listed above)
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 CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: ` Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ 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.
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 our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
5ighature o ntr ctor/License Holder
STATE OF FLORIDA
COUNTY OF Lok(,a'
STATE OF FLORIDA
COUNTY OF�
Sworn to (or affirmed) and subscribed before me of
Physical Presence or c/ Online Notarization
this ''day of ca 2020 by
Swoyrf to (or affirmed) and suhc r' ed before me of
i' Physical Pres nce or Online Notarization
this __?�( day of Q 2020 by
'Decyw\ �3_ � llm�
Ca4yvi
Name of person making statement.
Name of person making
Personally Known OR Produced Identification
`statement.
Personally Known OR Produced Identification
Type of Identification
Produced`` bL,~
Type of Identification
Produced 4
(Signature of Notary P b ic- State of)si'tlirid
Notary Public 5tei,,
t/"tl_y J ` t� Pamela Jones
Commission No.id� tiny co:r :< i .,.vrr c'smmi
REVIEWS FRONT ZONING SUPERVISOR
(Ignet a of Notary Public- St f
cx tfU
/ +r r jy C„ �.y�' 4t ota Public stela or Flori
on No "i t ,Jones
_ My commission GG 985470
�, F Expires 06/15/2024
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER REVIEW REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.