HomeMy WebLinkAbout5200 Matanzas ave permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
� r. LL��c i P
Permit Number:
Building Permit Application
Planning and Development services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial
PERMIT APPLICATION FOR: ��� ? C,� � -1
PROPOSED IMPROVEMENT LOCATION:
Address: 5100 96�oGzcts Avc i',-'rr o P
PropertyTaxiD#: ig3j- =jolt
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORD:
New Electrical Meter
Second Electrical Meter
CONSTRUCTION INFORMATION:
Residential
jai
k
Lot No. (0 -
Block
-Block No.
Additional work to be performed under this permit –check all that apply:
_Mechanical _ Cas Tank _ Gas Piping _ Shutters _ Windows/Doors Pond
— Electric _ Plumbing _ Sprinklers Generator n�
ih Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
e
Cost of Construction: $ C}Cj• Utilities: _ Sewer Septic Building Height:
OWNER/LESSEE:
Name
Address: 1" '01!% L- A irk.
City:`. O ,t a -C[{ State:
Zip Code: 31TIq 6 Fax:
Phone No.�l ,J'f)-i3"jI&
E -Mail: 1'!�iC�1r✓{ l' f ���� „pct' l t,�✓'s
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTnR
Name: r (/ Xyl �-oc i" (_ ,
Company:
Address:0- F )
City: h State:ILL
Zip Code:Fax:
Phone No c41 –1
State or County License 2910
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 INF=ORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER. _ 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.
certify that no work or installation has commenced prior to the issuance of a permit,
St. Lucie Countymakes no representation that is granting a permit wilt authorize the permit holder to build the subject structure
which is in conflict with any applicable dome 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 t 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 TOO ER: Your failure to Record a Notice of Commencement result in paying twice for
improveme to your property, A Notice of Commencement mu b orded in the public records of St.
I_ucie,Qou y a ote rn h jobsite before the first inspef o ten to obtain financing, consult
hx� af#1 I •ur, Q i. C mmencement.
,.sir lP pr an ot-n Cf re commencing work or re
ure of Owner/ L sse f"Contractor as Agent for Owner
Holder
STATE OF FLORIDA, ! rM STATE OF FLORIDA 0-r
COUNTY OF �1 Ltil COUNTY OF V L lel
Swol to (or affirmed) and subscribed before me of Sw95 to (or affirmed) and subscribed before me of
physical Pres r mine Notarization P slcal Pres c o n�le Notarization
this day of 2020 by this day of r 2020 by
M 1, Cho(1 cirkri r le)ut
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personaliy Known OR Produced Identification
Type afldentifica q��i/�Y_ Jr /)n j/j ProdType c d, cpt�v ( I+/�
(1 J�C.fi Y r �` j 1�, Produce 1 �/ I L
Drnrir�rarl 'IT--
(Signature of otary Pu Ii
Commission No ^'7l
g4f FIWA, public State of Florida
t` Melissa Wall
M gy�isalon GG 115639
P 4' IZ021
of F_
{Signature of Notary Public-
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Commission No.
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�Ww Notary Public State of Floddi
tP ell Wali
4�a: mission GG 115639
of M1 fl+ Expires 10/0612021
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