HomeMy WebLinkAboutBuilding permit application I li
All APPLICABLE INFO MUST,BF/COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: fJ�D 'F1 I�W
O - •
Building Permit Ap lication
Planning and Development Services
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:
,,'P:ROPOSED IMPROVEMENT LOCAT,I'.OIV ` ` _ •'� � � T}' N �F' � iF'
Address: � '� � S� us- \ pock St. L06 ( V-- H95•Z -
Property Tax ID#: �l.0 nc� Lec�.c-1 Lot No.
Site Plan Name: Block No.
Project Name: 4 1 C-,-E CP C e 1 Q-E
D_ETAIL`ED DESCRIIFTI'ON ,OF 1NORK' =t `
ri e 010 Cf- CA,VI A f����a C E T'VY-X e- \k el- Q )G's C�<yx i C—C (Y\e C\ A cr O-Al c1
1
Carr\2 .
New Electrical Meter Second Electrical Meter
CONSTRUCTIONrI`NFORMATION
Additional work to be performed under this permit.-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windo:v_;Door _Pond
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: Utilities: _Sewe
OWNER/LESSE`E '• :- _ -. ° ,y �`y$ s `CONTR4Ai
Name c ac Name:_
lhressi7 2[ZN% Compan, �a ry S``
City:�'751 S . LZS S�, State: Address: r_ na<� I S��l �� ri
Zip Code: Fax: City:3 I
Phone No. Z��'1 S - O ' �� Zip Code p`r S� L�
E-Mail: 0�k-tom' e'er'--LCcJ hej �utJ`��L io -T Phone Ni 77 R�
-7 7 2- - D - r4
Fill in fee simple Title Holder on next page (if different E-Mail_ -g A 4
from the Owner listed above) State or(
V _ 1 6 -t
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
If value of HA
VC is$7,500 or more�I a RECORDED Notice of Commencement is required.
i
s.r
SU�t?PLENtENTAL CQNS�TRiUCTION LtEN��AWht €O:RjMA}Tt4t+;�
rl*.9_ ,i.>sFsA' `,�h' .s.l.q "r'.*�xZ
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 Coun y and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with a or an attorneybefore.commencing work or rec Notice of Commencement.
gna caner/Lessee/Contractor as Agent for Owner Signa r on ractor/License Holder
STA E OF FLORIDA STA E OF FLORIDA
COUNTY OF COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed) and subscribed before me of
Physical Presence or Online Notarization Physical Presence or Online Notarization
this day of 2020 by this day of 2020 by
Jol�0 n �s� �.�'o-n stl
Name of person making statement. Name of person making statement.
Personally Known ✓ OR Produced Identification Personally Known tol OR Produced Identification
Type of Identification Type of Identification
Produced Produced
DW
(Signat a of Notary Public-State =•: Yi• : CQ�1�, ure of Notary Public-St FPow �� ►�
,` a
Commission No. '1 �`( '''• '� s :�� 9;QMssion No. C C7J ��o— •� •� _ •��•S�
"�np BMW ThIIVI Noby ��„a„ Tknu Am
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
i