HomeMy WebLinkAboutHPSCAN_20200930211930826_2020-09-30_212121597 All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
COUNTY
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: T /Q _S u s Hl(S//(.t/f}y
Property Tax ID#: .3y1y --50/ — /9a3 0/0 8 Lot No.
Site Plan Name: E• X. O L®g k' .Spa Block No.
Project Name: Dak SiDGt
DETAILED DESCRIPTION OF WORK:
JV ie, Q /20V o I?' ?• Gt" 2 a n k-/ .XY `t,ea,few !4•7d a o, Ake
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 _Windows/Doors Pond
Electric _Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name V�1 Q Y2.`�I Name: Ed W ar'0(
Address: Company: E .S•o 1 �2G tG
CitA� lJ.LSQ tate:,<,L Address:_5.10-7 Qa k1 m,-7 o1 lake C O.-
Zip Code: r- � Fax: City: F+. Pi eece State: FL
Phone No.a1__-a Zip Code: 3`/9,5-/ Fax:
E-Mail: �Qr10mm, t - )W Phone No (579-l �S-0 �l/ -7
Fill in fee simple title Holder on next page(if different E-Mail 2 S _few-Vic ej®q."'g Co w_
from the Owner listed above) State or County License E-C QQ0 qqq_?
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 MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone 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 atto rnev before commencing work or recording our Notice of Commencement.
r-
Signature of Ow r/Le a/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID STATE OF FLORID
COUNTY OF ��'C - I_C�„G`IJ COUNTY OF y Cto
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
V, Physical Presence or Online Notarization 'k Physical Presence or Online Notarization
this ay off �a . 2020 by this S ' ,
day of J� ��-ti Vi;y ,2020 by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Iden ation� Personally Known OR Produced Identification
Type of Identification I a Type of Identification
Produced �C' 1 +� . < Produced �;(' L.
t In -Notary Public State of Florida
tj� —1 (~ � v 49 Mona Leon
My commission GG 230893
(Signature of Notary Publi - (Signature of Notary Public-S to r'
00 n Notary Public to of Florida
Commission No. 7� K ggh�{Be ;b
M�r`hFhiss�onGG274003 Commission No. (�Y�'ts(}t°) (Seal)
� ' Expires 11/05/2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 562