HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Building Permit Applicc°tion
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Commercial Res.dential
PROPOSED IMPROVEMENT LOCATION:
Address: 1ot'q3j '0 I2 �bne'
Property Tax I D #: 2321 a 60 " QQZ-Z ^ GCC)1 Lot No, 2 Z
Block No.
Site Plan Name.
Project Name:
DETAILED DESCRIPTION OF WORK: AQ�p1 Lo e-ede4. RQ-na�.P ra-4
¢nc, v ( cud k9Lp la en1 tee ALbckc
'last u l�tsWl I sec ( q CtC
ve1tuv'e
v
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
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: � flt4 :S
Cost of Construction: $ ia, 00000
OWNER/LESSEE:
Name -TUI i?up(�
Ili•
—Shutters _ Windows/Doors _ Pond
Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
Address: I C I0,6— Vl Y- Ut I K- U V ri
City:State:
Zip Code: �J ��I� Fax:
Phone No. �l 12-�r3 _ 132lt�
E-Mail:+Lilt '[P-11wig I ro), QYYI(f.(wry)
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name: �-p rw-cOf � `L-
Company:. T[OiAd t
Address: Ieq
City: +S4 LUC'L6 SStater
Zip Code: 3LIGjZ Fax:
Phone No Ce Z.0 eb
E-Mail qttcc�
pr5I (C C��iti'1
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:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
BONDING COMPANY: Not Applicable
Name:
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.
a
(SlIgnatur:eZo
caner/ Lessee/Contractor as Agent for Owner
i ture of Contra /Li ense Holder
STATE OF FLORIDA
COUNTY OF 9 b-CCALQ.1
STATE OF FLORIDA
COUNTY OF
Swo o (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this L(� day of S ` o r - 2020 by
t4 c- C R.txYinrl
Swor o (or affirmed) and subscribed before me of
V Physical Pretence or Online Notarization
this � day of �_z' ��n Y' , 2020 by
-Q E-0►'� l , ��
Name of person making statement. t�
Personally Known OR Produced Identification
T�yp f Identificion
Name of person making statement.
Personally Known OR Produced Identification
Typaen ication
Producec L
ro
(Signature of Notary l
Notary Public State of Florida
Pame{pp��,�n�
Commission No. �" MyCort�miasidrSGG 985470
q� Expires 06/15/2024
(Signature of Notary Pu ic- S orlcl,, Public State of Flom
Pamela Jones
misswn GG 985470
Commission No. ` r[U06j1S12pQ4
41
OF ac
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEATURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5