HomeMy WebLinkAboutEngineering All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (�
Date: -' lU�� Permit Number: UQd b j
Building Permit AP licatio AUG 2 2"M
Planning and Development Services 3;t - en1_
Building and Code Regulation Division Commercial ReSldeViIn.tial _ -:c FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)'462-1578
PERMIT APPLICATION FOR:
,I N
}A . . x,E� �' x°x` �?E,:xi. .� ?I:!K�tu� �
Address:
Property Tax ID#: _ a y - `' o Lot No.
Site Plan Name: Block No.
Project Name:
�r 3 s-.;r r-"+"r fr., t .:x.;r ' :F' r»4•i-'+ ��x' e y 'ks�-t'4,� 'Y' s s,Y".r"x t}-` 'r ,s r;,, ...,
� M id3.1��'�3
a' .,�` 4�u 4'o y �" L (� •*k� r i .�` �. 7x k' x s ! ..aF
+,.t''�T^-,�R�.,����'S"°"t4�=�5�;�. .,6.: yyi'�� z.1s',.�Y���`L� ;Fa. `•,�^���� e;,,i0.'4i�:S'.''�dH`.�+`.�.i.:n s,�tri��k��{� `�...c�'����''s-.t
b 3•' uet n��_.c-,. T.-`4,.1 _ C 1._. _a..M� »C,R.�.x err"..
A6 G
New electrical Meter Second Electrical Meter n�
-v �s.:�Re;�=w5' q.h e�'s'9p �,�1•z",�..� � �;s?�3YE�.'..; ';.s'�`* �.-'2t � `e§��.�i"ip:�"kyf�'���it''`e (.5;' ,�`-.'•hy_.-�sI'���fi M�.,�.'.� w,"�..�$?y¢` ^'� y+�'Sl s'��''a+,�� �}.i''k
s �.''�. � ��� � !'1G �'�'� � �-.,f& :=1: S � s.... Y r'�i �'I'+;G+,;-. ,v•W '� � ^.q,�jy �-r �r'� t
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping —Shutters _Windows/Doors /—Pond
_Electric _ Plumbing _Sprinklers ^Generator '-
doRoof / Pitch
Total Sq. Ft of Construction: C3 U ,�> Sq. Ft. of First Floor: v c>d
i
Cost of Construction:$ cYZ/6' Utilities: —Sewer _Septic Building Height:
��,vJ���f(��:..�F(�R ��,,.0 CC f4. i:.. .-.c 4nF ke SYL:Sw• S a/pC�.�� �pl tn3' (�+�'>r� t'tt--GI jYY_, y.,� 3-Sz � t�y�hu1R 's:.51 Y.°.-
Q•Yr1�t a7 fir * 2 3 S x exFuf' � ri I
.�w.-.•T.n.l..i a.Y;i�.c 3`fit,.u._.>',`_,Z.?.a�,..^rY�:..:.>:S ,...�,!!Y.._as :`..}L.,. ......_:r.A,...,.. xa'...u.`r.....�'}<.>_l ._,-..�?'::3.t a......�: ..._AFT ..?'
Name ' (. ti �� Name: �cy/+�/ _I� :fir
Address: tj6 ':� %ia4 p/1�C✓y Company: %�� LG �ffr�G / -•
City: State: Address: . D
Zip Code: Fax: City: AtA Zf Stat
Phone No. -iL / 3(4---�-X% Zip Code: Fax:
E-Mail: Phone No 7 -0? a-'3
Fill in fee simple Title Holder on next page (if different E-Mail • WA& 0-
from-the Owner listed above) State or Coun `License
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.
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[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 record ed.-in•the'public.records of St..
Lucie County'and posted.on the jobsite before the first inspection. If you 'intend to obtains financing,.consult
with lender an attorne before commencing work or recording our otce of Commencement.
Signature Owner/Lessee/Contractor as Agent for Owner Signa r ractor/License Holder .
STATE FLORIDA STAT?o((or
FLOF�IDA ,
C.OU 1 OF 5 k �J c�� COUNOF
Sworn to(or affirmed)and subscribed before me of Sworn affirmed)and subscribed before me of
Physical Presence or Online Notarization k Physical Presence or Online Notarization
this 'a, d'ay of ��i ,20a.a by thi`ts� Z,day of c3-:=?vv c 20ad by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR.Produced Identification
Type of Identification Type of Identification
Produced zc�- �- Produced �L
(Signature of NotaHy Public-State of Florida). (Signature of Notarl P
DEANNA MARIE GIVENS
Commission No<'b��-6 _•"'+; : (Seal mission C mission No.
v t w MY 00M�,� #GG 022023
MY COMMISSION#GO 022023 -,� •oz EVIft�SI ber 16.2020
�"'• .'i" EXPIRES:December 16.202 , �'% oF Fta"• Bonded 7fw Nogry Public Undervrrtters
,...�,.
LL
gl,• Bone o
11 ..... .
REVIEWS_ FRONT OR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.