HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
L ` " 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:
PROPOSED IMPROVEMENZ
Address: -I(Aj0 S O(tM Driyc c(&n Ack) 1 t. : 4giS 1
Property Tax ID #: _4 502 - (D 10 - OOOO - 000 - QO Lot No.
Site Plan Name: Block No.
Project Name: B Inr e.C_S 13011e,f'
DETAILED DESCRIPTION OFIWORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMA#ION:
Additional work to be performed under this permit -check all that apply:
X Mechanical _ Gas Tank Gas Piping _Shutters -Windows/Doors _ Pond
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction': 1 2 Sq. Ft. of First Floor:
Cost of Construction: $ U A , I C1 .) - UO Utilities: -Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameacQritkccS Co
c colon
Name:, i Cif - eneco
Address:41o50 S OceanDr cF
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w t�vi,nsr,n
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Ci3rn iany: till ymt 'SPmcc COf(Iparq LPL
City: Ocr scn BC40,
Zip Code: 3y95-1 Fax:
PhoneNo.112- ZZcl'Cl(pcIU
State: FL
Address: -21 ZS Andauns Rk '3
City: , LGiU(�ef G�0.IP Stater
Zip Code: S3SI(0 Fax:
Phone No_29(Dla-52`j-�200 "t• 2j602
E-Mail:_:jVx9YtfY,eSSrc)r1Cia&9mo1I-CC)
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail CbCIf Yt1 @ It I� t IDYIe .
State or County License 0- c t 25 ou 4S
.,o .ut— or —mencemenr,s regwrea.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 Countyy 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 obtai financing, consult
with lender or an attorney before commencing work or recording your Nnt4d of Comen mcement.
Signature of Owner/ Lessee/Contractor as
Si nature of tense Holder
rner
STATE OF FLO�P
STATE OF FLOR
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COUNTY OF�_�� (
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Sw rn to (or affirmed) and subscribed before me of
Physical Presen Online Notarization
S n to (or affirmed) and subscribed before me
Physical Presence
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thiaZ -day of�T� 2020 by
or -Online Notariza
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Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known ) OR Produced Identific
Type of Identification
Type of Identification
Commission No.
e otlfvflf 9J ERICKSM I
(Suture of Notary Public- State of r0oridaW0WM=KAIA00234W
_19PRES`i8&Aw31,2022 Commission No. (Seal
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