HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
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:
I PROPOSED IMPROVEMENT LOCATION: j
Address: Ia r-4-1 17U_V_ . i 34c) ) (
Property Tax ID #: 241Gj • 34Z-0001 .000• c-P Lot No.
Site Plan Name:
Project Name: a2r-)(.) Q-Q R �
Block No.
DETAILED DESCRIPTION OF WORK: to
P (,Ga ��; ; pr ` n6� ro �A� , `
�o �n d , rc In ��, ���� �� ►�.e..e-c�e.r�. ���Ta,i 1 OC -r[���um ��1.:� ` a �� lat
vf,l-aU r\e.)n o o . "--(c' 4 z)JUM rAbusvW-C*�_ . fns[all din c,"�A 0'aL r -X. luttv ram{
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 1z oof Pitch
Total Sq. Ft of Construction: "Zia00
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name JD�Anrv-A (".VIt)
Name`;
Company: Flo"a t&Jl L� k(A-160c, 130)v-6 b
Address: ac 1-4- NkALd QJ
Address: itM St-G , % tC4w
City: LLLC,�C._ tate:
City: a0WYL,1z State: Q!
Zip Code:. '3� e P Fax: t� � of
Phone No. -�. - 43�Dd __10 3
Zip Code: _Z-AcA52 Fax:
E-Mail:
Phone No-1-1'2-- L02A a Lro21.c2 e:�
Fill in fee simple Title Holder on next page ( if different
E-Mail dfflCe__&Q V.S I IC • w rt A
from the Owner listed above)
State or County License
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
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: Not Applicable
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 intend to obtain financing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
Sig of Owne / essee Contractor as Agent for Owner
ignature of trac o�_r�/U_ic`ense Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF . CLA W-Cl -)
COUNTY OF `l- LLCC"v�
Sworn to (or affirmed) and subs ibed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or � Online Notarization
this � day of ALLCI"-C 2020 by
Phyys�ical Presence or Online Notarization
this IcAay of Ltd; LtA+ 2020 by
,
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known _j�OR Produced Identification
Type of Identification
Type of Identification
Prod t> -
Produced
(Signature of Notary Publ'-�ta,tP�of �ridad Florida
blic Stele
��.jj,, otary uof
(Signature of Notary Public- to of Florida )
�I . Pamela Jones
Commission No.0 �l - my GG985470
Commission No teofFlorida
of Expires 08115/2024
NweryF ���
i4 Pamela Jones
GG 985470
Expires p81151
024
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATI y o
ti
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
3ev.5/6120