HomeMy WebLinkAboutStilwell Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
° Building pp 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: 12-05 M CA VS -6I A
Property Tax ID #: A5c)2--6b I'js)-2 ° cx:)U• -2- Lot No.
Site Plan Name: Block No.
Project Name:t
DETAILED DESCRIPTION OF WORK: l `'ff �I�t-✓+�st
tie.-P'C�"
k 02�
CLc,
a-AF-n TW�
0L- (-E,, nt--.ede-& c-ncl oa
It �
New Electrical Meter Second Electrical Meter nsfa-1! �
�e� vc� l nrw P 4-0
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
Mechanical
Electric
Gas Tank
Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $`J (i
_ Gas Piping
Sprinklers
Shutters _ Windows/Doors _ Pond
Generator -,-�-oof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:'' I
OWNER/LESSEE:
CONTRACTOR:
Name (Jamus C' `" '
Name: 0&"U-ipirl Oxupe- '
Address: 12oS 1-e-5 iJWd
r i
Company: 1 (pvtD�f',-a���1�, CjOI
City: ` a Mn 13e a -or i State:
Zip Code: t��- Fax:
Phone No.
Address: 15 ��. SC � MejY-\C-e,(" ctrct-'
City: �r`F U.C, _ State: VI
Zip Code: L7Ac't�52- Fax: N
Phone No --H2-"Q211 -(o2,bi�
E-Mail:
I
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mailnff'tct� Cz -hers! (L �Lorv-\
State or County License CCC. ('jam 12(ti j
It value of construction is Z500 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 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 lender or an attorney before commencing work or recording our Notice of Commencement.
Si ure of Owner/ Lessee/Contractor as Agent for Owner
Si ature of Co i ctor/License
i q
STATE OF FLORIDA
COUNTY OF lei (�
STATE OF FLORIDA 11
I
COUNTY OF 5J
U'0A
Sworn to (or affirmed) and subs ibed before me of
Phy ical Presence or �/ Online Notarization
this day ofF7.7 f'� 2020 by
Sworn to (or affirmed) and subscribed before me of
i,/ Physical Presence or Online Notarization
this day of 2020 by
_
J
Name of rson making statement.
Personally Known OR Produced Identification
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Pr uce
Prod A;
ALT 0_1 C�IWAJ
(Signature of Notary Publ'
(Signature of Notary Public- S e of Florida )
Notary public State of Florida
Commission No. PariWsOon,es
y�y N g My Commission GG 985g70
Expires 06/15/2024
Commission No. & (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20