HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
( uu RECEIVED
hi
OCT 2 8 2020
BuildingPermit Application
Permitting Department
Planning and Development Services St. Lucle County
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: r y
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P,R®P�OSEDIMP�RO /EMFENT�LOCA�TCjNt _fx� ` ': � :: .�Ts �q.a
Address: i1 "� S$ Fj' rot4CY0P-00K Fvki- loiCiQCE fA. BOY5
Property Tax ID#: � l7 'c � Lot No.
Site Plan Name: Block No.
Project Name: J aU ep V1
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New Electrical Meter Second Electrical Meter
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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: Ix,, -_ Sq. Ft. of First Floor:
Cost of Construction: $ SOO Utilities: —Sewer _Septic Building Height:
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QWNER/,LESSEEu ;� rf, CONTRACTOR �, �- �
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Norrie"~± P�az:�l.e%.._..p-�vrr+MEIL Name: T�Guid fl He-be-k
Address; .I 88 ''S7ojE.l 82ooK
city o2r:` PIcBCG Stater Addressti-1ct.rbr4e-g
Zip Code: -3!l9 lS Fax: City:�or"r :Sf l.t�c.i Stater
Phone No. Zip-Co e: 5.'� ;Fax:
E-Mail: D c h u m 5a 35 reD c rnki • even Phone No -) - 28 1 9538
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License /�ej y 78
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.
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=SU . PLEMjEN�TAL�CONSTR�I G :RE , EN LAW 111FORIUb 11,55 ��v;Y �
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: ✓ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: v/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 l 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
with lender or an attorney before commencing work or record' ur Notice of Com encement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLO DA
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 (�s ��,�r_)•P r 2020 by thi day of T`�`�11'�\0�� I , 2020 by
0�", 'C� C-y_ 1-'v_ wtf C CAU 1�
Name of person making statement. Name of person making statement.
Personally KnownOR Produced Identification Personally Known _OR Produced Identification
Type of Identification Type of Identification
Produced Produced
U22 no- - I ��5 9 0- , W" -1 -
kinature of Notaryu lic-State of FI r da ) ( ' ature of Notary bl -
Y P"'• YVETTE ELI7ABETH PEPPARD
:° ION#HH 000307
Commission No. "'+Pg y�(IfELIZABETHPEPPARD mmission No. _ MYC("
MY COMMISSION#HH 000307 `a r �` � r: EXPIRES:August 8,2024
a: ''�F• o?` No Public Undernrilers
Bonded Th Notary Public Underwrit rs
REVIEWS FRONT r' LANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.