HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I N Z y Permit Number:z
RECEIVED
o h! ll OCT 1 4 1020
Building Permit Application permitting DepartmeW
Planning and Development Services St.\de oust.
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:
77
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Address: ILF 4.c
22 f Lot No.
Property Tax ID#: � J® � 0
Site Plan Name: Block No.
Project Name:
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S`CRIPTIO ; ®FWORKs5 x� jt ,« Y �_
DE�Ti411 E
ems`,;1 ` k ?':,Se`k
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New Electrical Meter Second Electrical Meter
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CONSTRUCTIOI�,,1NFQ tMATI<ON
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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: $`Z(. �� Utilities: .—Sewer _Septic Building Height:
1'M,y
OW(VE{R/LESSEEr � r e ��
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Name�4 RfLZA � 2�+�5 me:& U (0e--C ,,- C 14;h Q1z11 .
Address: W 7"3S ! )`-clC7z-- A- 4ompany:�
City: �_ l'z ?,;�z iC Cc State:!'< Address: 2`� S Q!, KuRA U D P C
Zip Code:3�j S 5 l Fax: City: Stater"L.
Phone No. 7 71- S` (' 3 V63-3 Zip Code: Fax:
E-Mail: Phone No J7-L
Fill in fee simple Title Holder on next page(if different E-Mail bA eAZ-KO ems(`e-e o L�w
from the Owner listed above) State or County License C J(A 141. k4 S
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
OR�1 4 Mtic,?4-""�AP-•_Ty;f,�YI'7O.t'y,-;(H.�-.N'4'�,F4GY.n,S.r",+.=;..&,$�f 2k�rrr�= $,�v.SS`•v�.s�_n;7.'��'^'S!!t��a',.t�7`t,.:�:r y�,?"r",,,�r r`"�.,i°'',k,��"�i4l�'��1 tf,
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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
itl�I- der or an attorne =before commencin w -ar�cordin our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Si nature of ontractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �, • Q a ; COUNTY OF L, • `
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Pres ce r Online Notarization Physical Presence or Online Notarization
this—a day of 0 2`020 by this day of 2020 by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification
Type of lclentiftaUon Type of Identific
Produced L Produced
(Signature o Nota , (Signature of o �ayP,u Ic- SEN
-KAREN S. NIELSEN .;P
`PAY PUB'""' , ! `nc State of Florida-Notary Public
;20 �-State'0f FlgqFFidaa,�`Notary Public '. •_ Commission # G(4 �484
Commission No. _ = mrnissid�i41GG 207484 Commission -
NI Commission Ex ires
My Commission Expires °'%$;,°;°Q`` y June 12, 202z�p
June 12 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE . MANGROVE
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DATE
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COMPLETED
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