HomeMy WebLinkAboutPermit Application, signed by contractorAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential 1 .�
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: a V /Notes Ov 5�r,.S��� e4,r, I f I- 3Y I rr%
Property Tax ID #: ("� 00 e e Lot No.
Site Plan Name: NP(�F PS 7-S �4Nt (oxW. - Je6 f�c�s" Block No.
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Project Name: ktf i C I as Re42-1, 1-
DETAILED DESCRIPTION OF WORK:
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_ Qti� Scr-Pr.J;n� ��� Pfcf Ar 12/N(Ae
S 4(17r"- `.S 5 tSe ran S1�.���'�. Pelt,;
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION: 1
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. Sq. Ft. of First Floor:
Cost of Construction: $ '3 T�o� Utilities: — Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name -- - - -----
Name- TL(o:^ayJ
Address: d �" <, .�
Company: P S Pf 4r, 6i�y
City: /� '�rYnsP.v tee-4c4 Stater
Address: ` 46 AJal ;414
Zip Code: Fax:
City: 1-k I l yr w c c9 State:
--
Phone No.
Zip Code: s'-' o ? Fax:
E-Mail:
Phone No?0 —0d`/
Fill in fee simple Title Holder on next page ( if different
E-Mail�� lkt►�L i" v9 1, o C., C
from the Owner listed above)
State or County License C kC'/ Q
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: 3 I i't t1t—v
City: S'r-k 'Stater—
Zip: Phone —c -
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Address:_
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 commencingworkk or recording your Notice of Commencement.
4-�
S nature of Owner/ Lessee/Contractor as Agent for Owner Suture of Contractor/License Holder
STATE OF FLORI
COUNTY OF - • 11A CA�
Sw to (or affirmed) and subscribed before me of
h�yslcal Pre enc or O ;ne Notarization
this ay of -� 2020 by
JI-C6 f 1'Yi 41 (Vk
Name of person making statement.
Personally Known —LZO R Produced Identification
Type of Identification
Produced
STATE OF FLORIDA
COUNTY OF_ � �1 , W C)
Swor (or affirmed) and subscribed before me of
h sical Pre enc or 0 line Notarization
this day of ° 2020 by
:1DWn .01 (Q-
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State I6 �, SHELLI LEST R( I of o ary Public- State
;p/��e State of Florida-N tart' ubtic+�
Commission No. -• Commission N G 19463,a
(`®F.jn°#
My Commissio �y Wyssin No
March 11. 022
''fir tote of Florida-N tl
- tote of
# G
,, SHELLI LEST Rr2-
±� ��: My Commissio
March 11, 0
34
s
REVIEWSSS
FRONT ZONING SUPERVISOR PLANS VEGETATION SEA
TURTLE MANGROVE
COUNTER REVIEW
DATE
REVIEW
REVIEW
REVIEW REVIEW REVIEW
i RECEIVED
i
COMPLETED