HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPEL _,, FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 2Q% 0 -3 J!�
01ro ���II�'4 RECEIVED
AUG 2 4 2070
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: S,C
PROPOSED IMPROVEMENT LOCATION:
Permitting Depa m
St, Lucie County
Residential
Address: 36 �� �Me 1,id V
Property Tax ID #: 86_!E�— ®j67 --(Oo — i Lot No. 17 AllI
Site Plan Name: Block No..
Project Name:
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 V Windows/Doors _ Pond.
✓Electric ✓Plumbing _Sprinklers _Generator ✓ Roof Pitch
Total Total Sq. Ft of Construction: TR 97 Sq. Ft. of First Floor: 15173
Cost of Construction: $' Utilities: _Sewer _L/Septic Building Height:
OWNER/LESSEE
CONTRACTOR:` '
Name_ T&E2 AR 00 - A`(A LA
Name:
Company:
Address: 1 h ICE C n Gtm r.l /3 , Av c
City: F_Q 9T P � =- Re r State:
Address:
Zip Code: 3 4-U-2 Fax:
City: State:
Phone No. 772 — .Sl q— 2110
Zip Code: Fax:
Phone No
E-Mail: _, EkAp1702612-06H A►L_ Cmd
Fill in fee simple Title Holder on next page (if different
E-Mail
from the Owner listed above �cJ�—�
State or County License
IT vawe oT construction is -zbuu or more, a-RiSEMDED Notice of commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name: jm mAi) A. /-_AIe--n a
Address: /,oS F_/ tJc,j2FgF_ pup 9-r-__-7
City: wcsT nALm Jar hr_F1 State:
Zip: ,s3Ya5- Phone s"Zi-20et- 17ie!-
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
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.
4��q 1 'J �
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Si wne ontractor as Agent for Owner
or/License Holder
Sign re of Cr0RIDJ
STATE OF FLQRIDA
ATE OFF.
COUNTY OF, ill j�-�- �1AP
v =r -r—
COUNTY OF1(fl-iQ-
Swop)-to (or affirmed) and subscribed before me of
Sworn (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this'''" lay of Zily- , 2020 by
Physical Presence or Online Notarization
this may of 11A h Q, , 2020 by
S-r- ,(! C1'c), Awal Gt
TP.Aen& lAy&A-
Name of person making state ent.
Name of person making
statement.
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Personally KnownV OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Pro d
"unn 2LK:2:)
Produced
D4 �b'aw - '
2
(Signature of Notary Public- of Florida)
(S nature of Notary Public- State of Florida )
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Commission No. PRISCI 1�1��)RIEREYESGAIdEZ
Commission No.""Y" PRISCI)�I[f REYESGAMEZ
MY COMMISSION # GG325831
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MY COMMIS ION,# GG325831
aVEXPIRES; April' I8, 2023
y:101
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Rev. 5/6/20