HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
' r 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 IMPROVEMENT LOCATION:
Address: RS(o /UCtfles Blvd Soh6e0cti tL 0yysY
PropertyTaxlD#: /a0060 _ Lot No.c�8(0N
Site Plan Name: Ne Hl,'S is /Q ho� r N G A �o N cJa - .SPci7a N ?1 Block No.
Project Name: er'TIC D Y: c 420,P4 / r-
DETAILED DESCRIPTION OF WORK:
SS�tr'r�'tF' o� l( /�is D r•J 4/% �/I4SS'".5' Gi�e�� 2H a ddiT7/►+ !� 4�G!/nF'
Q[�� 5(j1Qw�itC Gf., A) la-CP wl%V rUSZP" CUT p/liSSPr �%/e�CS ;J/'u^
o,0o2t3 4/sa c�S�r/G� /UeA., &cCoSs
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION: I
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 _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 71 4 L a r
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: t("
Address: U9
Company: V5 ur-1 1 '� J(-
City: M 4Quo► 7-,f Stater
Zip Code: f Z0(od Fax:
Phone No. 2/ (e - 53o 7- S ZS/
Address: R(r'3I �iti Z. � " cous t-
City: `I o �Y��� Stater
Zip Code: 3 Fax: N%i4
Phone No
E-Mail: S'f�ahyoa(irP 610C g(oba. A,e f
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail PI46 Pt LM ts i'`'Lj � h Do, �^
State or County License l_- WP4
C&CIf S
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: t4 g T+Et; £Aibt.-,eerrw o, CoanA
MORTGAGE COMPANY: ✓ Not Applicable
Name:
Address: .2y31 SSE. 'Dixre
/4/4o-.P�Ay
Address:
City: SruaCr
Stater_
City: State:
Zip: A!J 294, Phone 77,2
-.'Pfs'7-0S Z r
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 your Notice of Commencement.
YO Q�lj
Signature of Owner/ Lessee/Contractor as Agent for Owner Si ature of Contractor/License Holder
STATE OF FL£iit-IDA /00- C. STATE OF FLORIDA�11i
COUNTY OF iGiOk .S t1Yl- , COUNTY OFF_
Sworn to (or affirmed) and subscribed before me of ; Sw rn to (or affirmed) and subscribed before me of
thIx Ph sical Presence or Online Notarization Physical Pre ence or Online Notarization
s 2A day of ��Ctri� 2020 by this day of i 2020 by
Name of person making statement, ; Name of person making statement.
Personally Known OR Produced Identification
Type of Ide tification
Produced_ W" 12LrC-�
(Signature of Notary Public- State of
j MICHELLE WELLS
isslon NO 82087
c�(}
Commission No.
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Personally Known _' OR Produced Identification
Type of Identification
Produced
1pignature of Notary Public- State of Florida )
1 `
mission No.
PLANS I VEGETATION
REVIEW REVIEW
i
.s; ,;"SHELLI LESTERJ�VR SS
:State of Florida -Nora ublic
:s
9 34
y Commission E}�o es