HomeMy WebLinkAboutBuilding ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED rr�� n�
Date: Permit Number: D Q 10 (69
gy
0
`�" ° R" 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:
Address:[
Property Tax ID #:
Site Plan Name: _
Project Name: _
DETAhLED DESCRIPTION°OF UIlO.RK
3 E4,rr q U-2 4Y SLrfaS a 91,10\4""'t I A-i X, 10
New Electrical Meter Second Electrical Meter
Lot No.
Block No.
1 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: Sq. Ft. of First Floor:
Cost of Construction: $ S O 00 Utilities: -Sewer _Septic Building Height:
OWNER/LESSEE: ", , .
CONTRACTOR:
Name / AAM`0' My.%twet-L
Name:
Address: H7g 5A2rcn Ph
Company:
City: Q'aT Pirn2Ct5- State EL.
Zip Code: 3141gS— Fax: AA-
Phone No.aloof
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail: 4 MAIL•ca+t
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
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.
,,
1
I '.
,
l .. f9� k
I �
I
.ti
�. � 1
- ,I
r
—
—
a
'_
- .,.
'
.
1.
I
.�'f 1. •. _ .. �. ._
._ .!'...
_ �_..
.� I -�
� I I
.�
,I � !
� ,
Y1 � 1
I �
� t�
.�I,
�. I � � �
_
.I �
_ .. _�. i
�
.I
- _ • it .1��
�
a
_ �
.fli �� i..
��I .i� I .. ..
'J1. ' -��
qP
i.a
.� .. .. 9 �� l�' i ,
�., it ;I
�
� . . i
� . ,. . , .. l -� 6
LIEN
Name:-F;�'nbe-
Address: a a 5!4 inn e� sr—_1ern City: Uer V\ State: �L
Zip: Phone 2?eL 7FP,\— 44MO
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable I BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
Address:
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
with lender or an attornev before commencine work or recording vour Notice of Commencement.
A 21141�
Signature of Owner/ Lessee,/46ntractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF �
COUNTY OF
to
Swop to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
✓ Presence or Online Notarization
Presence or Online Notarization
thisQ a day of QdZ9i:F 2020 by
—Physical
this _ day of 2020 by
lavlcl M0,Yv,<.(1
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signatur of
c- State 0&60 WLSlNBt
(Signature of Notary Public -State of FloridaF�—� )
. NaMIy Ribu slab of "M
Commission N
GmmL 01f22M P2
Commission No. (Seal)
Cmanksim N0. GG ITMM
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20
r♦ ` rt ♦ � '' I i I. i 11 . i
.�91alLAY1}8>ui0'e9R-`_L.'L �"[6�-a R�
I,17} f.5?-iD E.i ii f"ik'Fl�j Yy c^i` 4.)
' N SS3S\S�\tit r<;,Igk� r� z.�Tanz� q!A �♦ ,S� :,� ,
i-.lu}'6tP �Voa�a•ycr�.e+yR'e��..!�.n�Tn'Fl•-_.a+sr s+.� .
i r