HomeMy WebLinkAboutBuilding Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
S 111_1 CC IIL-T R
Building Permit Application
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:
Address: /OJ /'FiutTA -'NT `,hoer rrifRee M. J4 mad
Property Tax I D #:3 ' 33 % -Q fit - �Ob ' / Lot No.
Site Plan Name: f� Block No.
p
Project Name: M1 C -Poo E • Dr..y4wy
DETAILED DESCRIPTION OF WORK:'
LoOEe �N-�eeF �it/rvG�E' Tt� S'HSNG✓�'. __ Anorou /gam Q4 164.
[�J
Me 3 ; ► r + a: is C19-fATmTf9 314CAI cFS -(' ova -e»a
New Electrical Meter Second Electrical MeterTiNCeo >rCAT Roef fG 94f17 _ R,)
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: 00 Sq. Ft. of First Floor: ;Oepb
Q %
Cost of Construction: $ /' S-00 Utilities: —Sewer —Septic Building Height: a
OWNERAESSEE:
CONTRACTOR:
Name OU NNIDENWEY
Name:
d6&, AtE
Address: r o-
Company:Acs PienNn2
ro Rat
City: -�- P%�iY t State: FLAddress:4¢J(
Zip Code: �f /+ Fax:
Phone N %%d CIR - Sw_lr/
7
C
City: r9 t"
Zip Code: 44
Phone No /
Fax:
Stater
E-Mail: lymr/!e f 4;t m Of4N+�i %• l'eM
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail 1 in hn iL &tx*n/b r-adr,
State or County License CC t /33/ldS�
If value of construction is 2500 or more, a RECORDED Notice of commencement is requires.
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 I MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City:
Zip: Phone
FEE SIMPLE TITLE HOLDER
Name:
Address:
Citv:
Zip: Phone:_
State:
Not Applicable
Name:
Address:
City: _ State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:_
Address:
City:_
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
,:a L. A.. -,+ hnfn rn nnr ina ,A,..rh nr rornrrlincr vni,r Notice of Commencement.
VVILII ICIIUCI VI OH al.
--
Signature of Owner/ Lessee/Cont c r as Agent for Owner
jSl�reof Contractor/License Holder
STATE OF FLORIq A
STATE OF FLORIDA Q
COUNTY OF 1 �. UG ! �--
COUNTY OF P#L/M
Sworn to (or affirmed) and subscribed before me of
Sw�to (or affirmed) and subscribed before me of
�l sical Presence or Online Notarization
Phvssiical Presence or Online Notarization
�iGkiba.- 2020 by
this % day of (l�[.4�ebtlr 2020 by
thisay of
0 VAIII nenhdy'!TO
l► .,
Name of person ma -king stateme t.
Name of person making statement.
Personally Known OR Produced Identification 0"0'
Personally Known �OR Produced Identification
Type of Id e tification
Type of Identification
Produced Q ✓. �! �C' _
Produced
of Notary Public- State of FI
of
r Notary Public S
(Signature of Notary Public- State of
Notary Public State
Commission No. #/7,�/?�5� ;� . ianASnow
commission H
of Florida
issl n No.I1f/.�/.?�eS� W IMYcommaslMy
0
jpa Expires0612112024
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20
g Fionda
012658