HomeMy WebLinkAboutBaird Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR ARPLICATION TO BE ACCEPTED
Date: �Permit
Number:
ATT
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: Or eS _42- Se r V Ice,
:.
WV
Address: C c, S . S4 ) ()r UCt 3 7
3y0a �p09 o (no � � 000:> S
Property Tax ID#: Lot No.
f07O(.
Site Plan Name: r-'Jd lVic+ (ye'G S Icy t ¢S - LI^' — LK QI ? Block No. ) `^
Project Name: (1 G 1 r C--
a' II . x 3
C�C-C'�r
CC\�
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit- check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters -Windows/Doors _ Pond
1--1lectr1c _Plumbing _Sprinklers _Generator Pitch
_Roof
Total Sq. Ft of Construction: I iy 1 (0 Sq. Ft, of First Floor:
Cost of Construction: $ C) Utilities: _Sewer _Septic Building Height:
e ' P £, MPM-1, A. i«T�-fix: yG. .^
_ _ c
• t
Y x
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Name—_1 Cam—
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Name: I G eC' a.
Company: r- <CS
s� Q f V ICUs
Address E EGS J't
I
City: (` t Jt)I e_('c P— I IState: F
Addr1e/ss:_ S(J U I �t X 1 w
Zip Code: 3 Lf 8 - Fax:
Sta e: r
Phone No. Z-.t (P rP
Zip Code:.-3 Z q ion fax:
E-MaiL•. 1 1 . /✓
Phone No -7-1 2 - S f,, cl- i3s
Fill in fee simple Title Holder on next page ( if different
E-Maiynr i C e, ir^ r re5foveaq-7coni
from the Owner listed above)
State or Cdynty License %7
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.
Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: -Not Applicable
Address:
No
MORTGAGE COMPANY: 'Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: LNbtApplicable
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 must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you}}nntencl to obtain financing, consult
with lender or an attorney before commencing work or recording; yourilot' . of Commencement.
Si ure of O r e /Contractor as Agent for Owner
Signatur of Contractor/License Holder
STATE OF FLORID
STATE OF FLORIDA
COUNTY OF �.L - u C 1e,
COUNTY OF S� ct C.t
jly
Sworn to before me of Q t 1
Sw4rn to (or affirmed) and subscribed before me of �'�e
(or affirmed) and subscribed
"'Physical Online Notarization
Physical Presence Online Notarization
Prase9 ,ce or
e or
this-2S day of Ja2020 by
this QS day of // 't_ 9 2020 by
5�i ►1� 63��r�
CACA
Name of person imaking statement.
Name of person making statement.
✓
V--�OR
Personally Known OR Produced Identification
Personally Known Produced Identification
Type of Iden ification
Produced L �30- 0 V0_ c/3'
Type of Identification
No
Produc tary Publicsmto of FtanCa
-
it-- White
a
Expt s0i� 23 287855
1%r Notary Public State of Ftcrioa
pYtp-4vpite
94^
(Signature N && rf Public- t� IoNW6 }nmissionGG2e7855
ig a e of of ry Pub ic- Statef o on a
'' EX0 01ro2/2C
Zb
tmmission�O -` J�
Commission No. !/
No. / (Seal)
REVIEWS
FRONT
ZONING SUPERVISOR
PLANS
VEGETATION SEA TURTLE
MANGROVE
COUNTER
REVIEW REVIEW
REVIEW
REVIEW REVIEW
REVIEW
DATE
RECEIVED
DATE
-
COMPLETED
Rev.5/b/20
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