HomeMy WebLinkAboutHoliday Out- Permit Application.pdfAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I nth lwr3–j Permit Number:
a ° Building Permit Application
Planning a d Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (7 2) 462-1553 Fax: (772) 462-1578
PERM ITIAPPLICATION FOR:
PROPO_JED"ll R19VEMENT IO.GATION
Address: 11U I
Property Tax ID #: ca?l – cco 40 Lot No.
Site Plan Name: Block No.
Project Na e:
DETAILS DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTR CTION INFORMATION
Additional Work to be performed under this permit – check all that apply:
—Mech nical — Gas Tank —Gas Piping — Shutters Windows/Doors
Pond
Electric Plumbing — Sprinklers Generator 4 Roof —1c;L Pitch
Total Sq. Ft f Construction: ( O'a Sq. Ft. of First Floor:
Cost of Construction: $ Q0, 000 Utilities: —Sewer — Septic
Building Height:
OWNER LESSEE:
CONTRACTOR:
Name
Name: Vt
Address: Imr,
Company: '
City:t State:FL.
Address:
Zip Code: 7 Fax:
City: 5i00V+ State:
Phone No.
Zip Code:a4f9Ri Fax:
E -Mail:
Phone No --CRT's— L5C5
Fill in fee simple Title Holder on next page ( if different
E -Mail
from the O ner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAS C is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLE
ENTAL -CONSTRUCTION LIEN LAW INFORMATION;
DESIGNE
/ENGINEER:
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
COUNTY OF MG2I 4ih
Sw to (or affirmed) and subscribed before me of
Name:
Address: I
✓ Physical Presence or Online Notarization
this da of 2020 by
Address:
City: I
Zip: I
I
Phone
Personally Known OR Produced Identification
City• a e:
Zip: Phone:
FEE SIMPLE TITLE HOL
Not Applicable
BONDING COMPANY• Not Applicable
Name: I
Name:
Address: I
CommissiiV
;. Commission GG 366991 (Seal)
Address:
City: I
,,�,. v��. xpires October r 9, 2023
.; �p Cres c ober 9, 202
City:
Zip: Phone:
Zip: Phone:
.01 I
REVIEWS
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that �o work or installation has commenced prior to the issuance of a permit.
St. Lucie Counttyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in coht ict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Pl6se consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideratilon of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordant 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 lerider or an attorney before commencing work or recording vour Notice of Commencement.
Kev. 5/6/10
Signatuk of Owner/ Le see as Agent for Owner
Signature o ontractor/ ' ense
STATE OFLORIDA
STATE OF FLORIDA
COUNTY OF LA2e-hsa
COUNTY OF MG2I 4ih
Sw to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physic I Prese ce or Online Notarization
✓ Physical Presence or Online Notarization
this da of 2020 by
this day of 111' , 2020 by
Name of pers n making statement.
Name of peron making statement.
Personally Kown %/""OR Produced Identification
Personally Known OR Produced Identification
Type of Iden7ification
Type of Identification
Produced {
Produced
(Signature of o -
`
(Signatur
,� .:Ye!t, ; THOMAS W. STEVENS
•.�R:'!••. THOMAS W. STEVENS
CommissiiV
;. Commission GG 366991 (Seal)
Commission Commission # GG 366 eal)
,,�,. v��. xpires October r 9, 2023
.; �p Cres c ober 9, 202
j' :r;' •• ' Dntoduil Thro Tmy Feln lnsurartcn llOO.3R5-7019
:,".... ' ' Rrnidial Tiuu Tmy Fain lnsusnoc.: Rik) 7019
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED,
Kev. 5/6/10