HomeMy WebLinkAboutDocScan RAUL SAMAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 'I Do& c�-- Permit Number:
or
a �..,
r .L o_ .>� � Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: - : (�, C�
Property Tax ID #:
Site Plan Nam
Project Name:
DETAILED DESCRIPTION OF WORK:
c ! C)Nk-)/ \ �A se.e- (_ / :15f
New Electrical Meter second Electrical Meter
� CONSTRUCTION INFORMATION:
Lot N o3 k
Additional work to be performed under this permit- check all that apply:
jlechanical _Gas Tank _Gas Piping ShuttersWindows/Doors _Pond
Electric Plumbing —Sprinklers —Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $4,, Utilities: _ Sewer _ Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Address: ZCompany:
City• mla m i State: � Address:
Zip Code: " �� 01, ux: City:} ,DrC-%� Stater
Phone No. LL 5 l o I f7 - I q E�LQ _ Zip Code:. 1 f Fax:
E-Mail: Ea -co ° �rn P Phone No - a- ` f� L
it
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) State or County License - sx--
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 INFORMATION:
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: Yourfaiiure 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 your Notice of Commencement.
IV 4 4 2-,1
` Z
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF �� _
COUNTY OF KW�-'Lf__� T
Sw rn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Swor to (or affirmed) and subscribed before me of
Physical Presencp or Online Notarization
This-M day of +1, 2020 by agtt�
this M day of 2020 by
Name of person making statement.
Name of per making statement.
Personally Known OR Produced Identification
Personally Known �~
Type of Identification m=Y��f
nnpr p�rqy
I P"Y FUG' AN9T11VG."1 i)UP4,'1
f Identification �r, s
,'
Prouce =SP Y'e�s -, AMAI�(aF•, 0!lDOi �
= MY ;OMMISS10i. 4 CG 174904
Prod ced .:,_
?
MY COMMISSION 4 GG 1
�, n
EXPIRES: 22, 2(!
vo
4 3G � � EXPIRES: April 22, 2022
�Bmd'6C! fhni hi'ta Public Undaveriters
2 �
�,pril
.�:.
•-•,S1iP41P,N'.t:X�dS:`Ja'IFH✓_l^sG�:Ml4'9rL1.
,
(Signature of Notary Public- Seta - -----
ture of Notary Public- State of Florida )
Commission No.0--(~( -� 4QL_J (Seal)
Commission No + (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED]
ev.