HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 30 .2000Permit Number: ra o-_6'71
-
° AUG
Building Permit Application i J
Planning and Development Services
Building and Code Regulation Division Commercial Resldential"-
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR: �� �prJ1Z ; yes a A S
PROPOSED IMPROV.EMENT•LOCATION:
Address: 020 of 1 N.I.c3 L-Aund onk LA/
Property Tax ID#: I-Iqd 5 - bOrj- OOL19 000 r I Lot No.
Site Plan Name: Block No.
Project Name: QSkCA
DETAILED DESCRIPTION OF WORK;
� o M 1s+ . LP Tbdv k 5(50 fir. A 1�Q1��T�' 4,vb ('✓�� �
New Electrical Meter Second Electrical Meter
CONSTR.UCTI`ON INFORMATION
Additional work to be performed under this permit-check all that apply:
_Mechanical ✓Gas Tank wGias Piping —Shutters —Windows/Doors — Pond
Electric —Plumbing —Sprinklers —Generator —Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ (91 b 0,�— Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE; CONTRACTOR:
Name /i r-1 QHS -LA Name: "�ES er5�e2
Address: n2oa 1 tip w, LAoa l OA IN Company: )5/osLdeA CA5 E)( 2eS-r
City: PnLf.1 0-d4i State: F/ Address: 16,50 5 �SAN•��
Zip Code: Fax: City: 1 "+uAtL4 State:
Phone No. 1—Wee— A94 •— 059 Zip Code: 3490iLl Fax: Va-75
.7,2
E-Mail: Phone No 7 - 7$ - 11 Al
Fill in fee simple Title Holder on next page(if different E-Mail 0 (poi, Co '1-
from the Owner listed above) State or County License LC a 6 515
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.
:SU'PPLEMENTAL 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 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 t e jobsite beforEtthe ' st inspection. If you intend to obtain. inancing, consult
with lendgr or an a me b o e comm c n w r or recording our Notie of CqMm n ement.
Signature o Owner/Lessee/Contr cto as Agent for Owner Signature f Contractor/License Hol er
STATE O FL DA STATE F FL DA
COUN OF �.�(, 1/� COUN Y OF if -t.Fyrl
Sworn to(or affirmed)and subscribed before me of Swr to(or affirmed)and subscribed before me of
APhysical Presence or Online Notarization hysical Presence or Online Notarization
hisAP-Aay of 2020 by this I� "9-slay of 2020 by
5
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification/\
Type of Ide ification Type of Id tifica ion
Produced Produced S�
(Signature of N ublic- I NaYffr tfry Public ub(Signature of Notary ic-Sta rid;0pe 1e Edlund- en
St Florida a
Notary Public
Commission No. c Commission No. £ @§ f Florida
�a Cmri HH006747 s �?Comm HH006747
Expires 7/13/2024 Expires 7/13/2024
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20