HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I �' � 'a� Permit Number:
0'013.
RECEIVED
NOV 0 2 2010
. '
P@tF�ItiI�A Departm9pt
Building Permit Application Lucie County
Planning and Development Services /
Building and Code Regulation Division Commercial V Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR: C" ry?
R ?CSEi I �RQUEM '_ t CCATI1. _. :� �.. e
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Address: 10000 5, CC.+=A1J _DZ. -vP/107
Property Tax ID#: Lot No.
Site Plan Name:_ 0C5AA1A SovTH CD-tjDomwiuMa UN)T-Iloz7 Block No.
Project Name:
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New Electrical Meter Second Electrical Meter
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TR��[�}I�1 �FORMATION41
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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: Sq. Ft. of First Floor:
Cost of Construction: Iq Sl7 Utilities: —Sewer —Septic Building Height:
- tE� LE Irk RA T}R ARI
Name/�\DDLFD IZAM 12EZ Name: GI'IP—IS P,06E2S
Address: I W600 S. 0(j5:A,J •afZ. # N 0'7 Company: COASTAL- ftuMGING
City: ,)F_-,QsEtJ E>C,H. State:FL- Address: ;97/ St�J [.AK_C 01?-Si L ,
Zip Code:34�(_[:�7 Fax: City: IPS L— State FL-
Phone No. Zip Code: 39993 Fax:
E-Mail: Phone No _77a "`140_114 (
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License GFG 1%99'c 6a-
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.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _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 Count 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 attorney before commencing work or recording our Notice of Commencement.
(JIAZ -k%VZ=L CAS- /Z rL
Signature of Ow r/Lessee/Contractor as Agent for Owner Signature of Con ctor/License Holder
STATE OF FLORIDA � STATE OF FLORIDA
COUNTY OF l,U+-c•+t� COUNTY OF owe
Swprn to(or affirmed)and subscribed before me of Swprn to(or affirmed)and subscribed before me of
JC Physical Prese ce or Online Notarization J- Physical Preece or Online Notarization
this_.2_day of 2020 by this�2L day of 2020 by
(��,v,s Ems Chas
Name of person making tatement. Name of person making statement.
Personally Known )� OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Type of Identification
Produced Produced
PN* Notary Public State of FloridaNotary Public State of Florida
TCARVAl HO(Signatureof Notary Public-SAri ommission GG 950192 ( nature of Notary Public-St tk �d� ccmm,ssion GG 950192
fires 03/22/2024
ern
Expires 03/22J2024
Commission No. ea mission No.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 5/6/20