HomeMy WebLinkAboutAII APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTEDAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
91Yo I l�
cc
Amows
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
1300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PRnanCXn IMnRnVFMFNT I.00ATION:
Address: e.
Property Tax ID if: "1 OCR �i -C200 - O Lot No._
Site Plan Name: Block No. -
Project Name: -
DETAILED DESCRIPTION OF WORK:
S' Seer K
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:
Cost of Construction: $ qa SinJUO
OWNER/LESSEE:
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic
Name FL CJIdz!-�(iyo "—
Address: q.3l l?c�R,✓ /3l�ar
City: _ GU/O.✓.. �� 1 �v1_r State: 4�
Zip Code: fax:
Phone No. - -ILI—
E-Mail:
Fill in fee simple Title Holder on next pale (if different
from the Owner listed above)
CONTRACTOR:
Building Height:
Name: E �C�f-,'Fy
Company: - v
Address: pV.A. /SZrA e7r . 4-
City: State:
Zip Code: 3 3 V 7Jr Fax:
Phone Na 5t - ]13- ll aZ�
E-Mai!
State or County License G ! /9
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.
SUPREMENTAI CONSIRLICTION ill N 1AW INFORMATIM
D1;.5IGNERIfNGINEER: Nol Appl„.ible
Name
Addlvw,
city. 71P Phone
tl�tt'
MORTGAGE COMPANY; r Not Applif-Ible!
Name.
Address:
City, Str�
lip. Y Phone-,
FEE SIMPLE TITLE HOLDER: _.... Not Applicable BONDING COMPANY: —Not Appltrrtble
Name Name:
Address:__ Address:
City' City.
zip. Phone:_-- Zip: Phone:
OWNER) 6_ NTPtACTOR AFFIDVIT: Application is hereby made to obtaln a permit to do the work and Installation as Wdicatied
I certify that no work or installation has commenced prior to the issuance of a permit.
St: Lucia tollrtt�y makes no representation that is granting a permit will authorize the permit holder to build the stA4M structure
r►hrch ism +xtflict with any applicable Home Owners Association rulrs, bylaws or and covenants that may restrict or prohibit such
structure F*ase consult Ath your Horne Owners Association and review your ck ed for any restrktrons 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 Budding Codes and St. Ludy County Amendments.
The follovwng building permit applications are exempt from undergoing a full concurrency review: room additwn%
accessory structures, swimming pooh, fences, walls, signs, screen rooms and accessory uses to anorer non-residential use
WARNING TO OWNER: your failure to Record a Notfoe of Commencement may result in, ayin 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
wTb__k'nder or an attomybefore commencing work or rec9tdinA your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF_. L40-COUNTY OF P6LVkrih --
Sworn to (or affirmed) and subscribed before me of
V Physical Presence or Online Notanzation
this day of ia►Y 2020 by
i
Q1,Ch teryl 1'§I & �Ch
Name of person making statement.
Personally Known /_ OR Produced Identification
Type of identification
Notary
Commission
REVIEWS I FRONT I ZONING
COUNTER REVIEW
RECEIVED-_ _ J7 - -
Swop to (or affirmed) and subscribed before me of
✓ Physical Presence or Online Notarization
this ji�_ day of QCt _ 2020 by
`Ai« y4"( w he-' ,
Name of person making statement.
Personally Known --,./ OR Produced Identficau&q
Type of Identification
(toLAMISSION IIGGo97
I(S ature of Notar)-0ubtrc- <.
ExPaRES k9W23.202
OWN, WWyRbkune�
mission Np�`�"" 17�7
SUPERVISOR
PLANS
VEGETATION
REVIEW
REVIEW
REVIEW
I COUMISS" 0 GG 0971
1EXARES AuFU 21.: _
OAI1R "--V "W t tyke. I
SEA TURTLE MANGRCWE
REVIEW REVIEW
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AHRt dava not e1lAlraa the pfo�reKsl Ysted on lhkr Grtlflcsle end makes n0 rCpresentallorrl, ralranl{es or sueranlen ere eR erwl assumes rw respotrs3alYy for,
the grvouttisl Wed on 11tk Certificate. AHRI espre" d6dakrye all IIabWW lot damages of orry kind adsint out of the use or performance of the prod"Ms), Ot the
uhaV&4vUed MmauQn of data listed on this Certificate. Certified tatinp we vatid only for modals and conlrturatwns L'stea In the
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TERMS AUD CONDITIONS "low
This grdl[maM and Fts cunlen[s are prtrpriebry products of AHRI- Thislertinused a cate snail only be ed lIndividual, persanel and
uvtMlderrBal reference purposm The contents of this Certfllcals may not. in whole or In pall, be reproduced; copier$ dlleanurtated: .■
artter+d Inca a cc-mputef dat+i ase- or otherwise uNhad, In ally fatm or manner or by tiny meamexcept , for theteerta krdefdual_
perwnal one conlldentLti refuterlCe. NR{OMDI'rlGii•1;, MlAlls'e
CERTIFICATE VERIFICATION a III]7rlrafRATICA
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arxd enter the ARRI Certiflcd Relem"" Numbet and the date on which the certificate was issued,
whi h a listed aboveand the Certificate No, wfncn is Irsted at bottom rtytt -- - -- --
ts2020Air-Conditioning, Heating, and Refrigeration InstitiLne CERTIFICATE NO.: 132473191078926 W
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