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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED f
Date: Permit Number:
P
RECEIVED
OCT O 12020
R Building Permit Application _
Permitting Department
Planning and Development Services St. Lucie County
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:
PRO OSE &MViTO&T 10 90I N:
Address: I A tKP-T_ ��1166
PropertyTaxlD#: Lot No.
Site Plan Name: AKSM 06EAT Block No.
Project Name: (Al-71T
_ DE AILED DE�S�RIPT ON QF WORK:
C ove' 71
�x rs7Ll� 6 177 _
pAwo, r" CALL= wa-d 61
(2 ALL ill TF,
New Electrical Meter Second Electrical Meter
CONST' IJCT N SU@0MJ1 TION•
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: ,i L Sq. Ft.of First Floor: ,v1
CCU_
Cost of Construction: $ 0� Utilities: _Sewer _Septic Building Height:
OWNER/LE�S�SEE: C(3NTRACTOR:Name yry (ti'ub Name n: � N ...,,. .. ,�A,/t/1.y
:Address: 13 2 f v6 Company: /rc�f
,City: FT,, p1me-G State: FL Address:1?43 �f.(1� i:✓fllsl�'�'�1��71��41�
Zip Code: $61 R Fax: A,' A City: P/9 C �`(-If' Sate: FZ
Phone No.' ��c .���.�'" `S Zip Code: CI�� d Fax:." .. .�..
E-Mail: L! Phone No 6 Y
Fill in fee simple Title Holder on next page( if different E-Mail Cl0t'e-l^o4 '2 Aoi_ 01
from the Owner listed above) State or County License CkC fS_S W ,�
L
e of construction is 2500 or more,a RECORDED Notice of Commencement is required.
e of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
INa
PLEM ANT L CONSTR+U TION LIEN LAW iNFORMATi• N:SIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
me: Name:__
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE H LDER: _KNot Applicable BONDING COMPANY: Not Applicable
Name: Name: n/ld
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 our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Hol e
STATE OF FLORIDA STATE OF FLORIj�
COUNTY OF COUNTY OF �"1 Sty' /TGc GPIJ
Sw n to(or affirmed) n u cribed before me of Sworn to(or affirmed)and subscribed before me of
hysical PreQr Online Notarization Physical Presence or Online Notarization
this day of l 20� by this day of 20_ by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identifica ion Type of Identification
Produced L Produced
(SignatYre C (Signature of Notary Public-State of Florida)
KAREN S. NIELSEN
Commission B`v;State of Floocommissirs# GA�207'484ublic
Commission No. (Seal)
My Commission Expires
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW. REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 5/6/20
FLORIDA JURAT
FS 117.05(13)— Effective January 1,2020
a" �ti;t��.;����•��;��t" �3n�'�E�sN '���t' E �.;" � �i;`�`;'s� r?���P "�z.3�':�i?�s" �r
State of Florida
County of f��` ,II
Sworn to(or affirmed)and subscribed before me by
means of
ysical Presence,
—OR-
0 Online Notarization,
this-.., day of by
Day Month Year
6✓GiA Z Awl
No f Person Swearing or Affirming
Si cure o Notary Public—State of Florida
Name of Notary Typed, Printed or Stamped
❑�roduced
y Known
,•o�Y��''' JENNIFERDOMINGUEZ
's,:-0k Identification
,,�„ �a; � Notary Public-State of Florid
3A: Commission"GG 345242
My Comm.Expires Jur.16.2023 Type of Identification Produced:
Place Notary Seal Stamp Above
OPTIONAL
Completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document: 64 le/�+
Document Date:� l?`d Number of Pages:
Signer(s)Other Than Named Above:
_ -- •�'��" "s�"�`s�:,��'a'r.����. '��*aka -�'-,ru�� a.�z.£�s��IDFs �i3'�:. r
©2019 National Notary Association
M1304-10 (01/20)