HomeMy WebLinkAboutBuilding Permit Application (2)All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 'Tl����{j Permit Number: 40-b7 1�5�1,3
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1S53 Fax: (772) 462-1578
PERMIT TYPE: Sawa,
PROPOSED IMPROVEMENT LOCATION:
Commercial Residential Vz
Address: '�2 /aX_ , y 14eyArz"lo is s/ 1
Property Tax ID #: /1O — Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit — check all that apply:
_Mechanical _ Gas Tank _ Gas Piping — Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers — Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ yY27-9 SO Utilities: —Sewer —Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name Name:
Address: Company:
City: State:r`'z_. Address:_?,#
Zip Code: 3Y 1F S7 Fax: City: SnA&I Stater
Phone No. Zip Code: ,y99J'r Fax:
E-Mail: Phone No_22:2--9aD-21, A Y
Fill in fee simple Title Holder on next page ( if different E-Mail { 74-
from the Owner listed above) State or County License_ J191�35
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required_
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: V-111 Not Applicable
Name:
Name:
Address: /gg.,l aid &y.CJ_ y�,c,�,rr //
Address:
City: _�� -��-� State: 1::r--_
City: State:
Zip: Phone �7�-�+'8
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 Nome 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
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF .0Q &Af7 ,/ _
COUNTY OF_ O�)dAVAI
Sworn to (or affirmed) and subscribed before me of
1J Physical Prese ce or Online Notarization
this ay of 2020 by
Swor o (or affirmed) and subscribed before me of
V Physical Presence or Online Notarization
this Z-V day of i J1 2020 by
Name of person making statement.
Name of person making statement.
Personally Known v OR Produced Identification
Personally Known rf OR Produced Identification
Type of Identification
Produced
Type of Identification DEONEMUECK
Produced
= isSION # GG 285220
EJCPiRE5: December 18, 2022
TW Notary Publictfnderwriters Fi'
Signature of Notary P lid" a of FloriagNEMU"
!+&Y COMPAi5S10iV #� G6 2nS220
(Signature of Notary P
Commission No. =;'�.: EXPIgcembert8,2022
FL,. Bonded ruNo Putlicumermiters
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/15/20