HomeMy WebLinkAboutBottone1All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
0
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: �t`�`J ��—��'� (��{� �r�,l�� rl✓l ��4C& � �— `t�
Property Tax. ID #: 54 1 C _ 5 [0r0OAW OOD —+
13
Lot No. V4
Site Plan Name: Block No. 12
Project Name: 7E-anet (,2 < to
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doorsf _ Pond
Electric Plumbing _ Sprinklers _ Generator Roof `E' f Pitch
Total Sq. Ft of Construction: 2 'i'
Cost of Construction: $ f 21 ' 000
Sq. Ft. of First Floor: ,
Utilities: —Sewer _Septic Building Height:
O R/ ESS
Name `SCAM ✓��-
Name: J-Shil< A -5( Vcae
Address:S OS 0LVe Glib
Company: Gr d
city:`- i51TSCs.iA+ U CU state?F t
Address:!8 �Q(— A 5�0 CaLbiuIsqT (Z
CitySCAI/ � State:` -
Zip Code: CA Wia - Fax:
Phone No. � Eby `� �� 52)
Zip Code: 3 1-+ CA Fax:
E -Mail:
Phone No 4�4 _ t3'� I ` 9 '25Ci
Fill in fee simple.Title Holder on next page (if different
E -Mail '
from the Owner listed .above)
State or County License 1:
if value of construction is 2500 or more, a RECORDED Notice or Lommencememi is requires.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINE
Name:_
Address:
City: _
Zip:
Phon
Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
State: City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
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 thepermit 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 pro jerty. ANotice of Commencement mus r orded in the public records of St.
Lucie Countyand pos onejobsite before the first inspecti . If y intend to obtain financing, consult
with len er or an orne bore commencing work or recorOng vpAfr Notice of Commencement.
Rev. 5/6/20
�.
`
Si e of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
-5c--c—
STATE OF FLORIDA
COUNTY OF
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Ph sical Presence or Online Notarization
Physical Presence o _ Online Notarization
2020 by
this day of_CXQ by
of
this..
i ^2020
�day
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification !/
Personally Known OR Produced Identification
Type of Ide i (cation
Type of Identification
Produced l
Produce
I
44
o Y
a li to of Florida
Y1.
i nature of Notary e �N'Igf>ii+�das 098831
I�YNi;;i2N�HUK
(Sign ure of otary ufil t9:E.yp!,,..
<mmission,GG 098831
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0427/2 1
Commission No. �
Commission No. 11
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE.
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20