HomeMy WebLinkAboutPermit app - relocation - HirschAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 0 .I-LQ�)o - Permit Number:
1 SLU
M.
D
4, _ °
& Building Permit Application
Planning and Development Services
Building and Cade Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: Kq L- cc�rj_, ag SRC &(IdW�eT c (- Uj
PROPOSED IMPROVEMENT LOCATION:
Address: -19 b ,/T-%-1(0 L.ck ke`� ) Foci uc, �VCt ��q CT �,.,_. ,. ..
Property Tax ID #: SY2 I _.ove3` �_,iq _ �=' _ _ Lot No.
Site Plan Name: Block No.
Project Name: i 1
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
Mechanical _ Gas Tank Gas Piping — Shutters
Electric ,Plumbing —Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $,`� J� +
Generator
Sq. Ft. of First Floor:
Windows/Doors Pond
Roof Pitch
Utilities: —Sewer —Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name .4\ SC !
C
t
Name: K
Address k2S
Company: '�?12LA-� A;( 0:r1r1 "41D();14 I&VIV, I C'P=
City: f7 - Stater �-
Address: 532 MQ,. rnri-h l°- t _11 I
Zip Code: A c Fax:
City: fo, (-L S4., 01UC'4�_' State:�
Phone No.
Zip Code: %b Fax:'_1Q - i I
E -Mail:
Phone No -Tl z - V I - rj(,o
FIII in fee simple Title Hodder on next Page ( If different
E -Mail t0 0 cl afa.44c� `-e-%J'�_<_ , Cr, r n
from the Owner listed above)
State or County License— er'ICo--')(Vq'�)l
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,SOO or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name-.
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Counter makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, ,perform the work
in accordance with the approved plans, the FloridaBuilding Codes and St. Lucie County Amendments.
The following building permit application$ 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 your Notice of Commencement.
f
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDASTATE
+ `LuCW__
OF FLORIDA G
COUNTY OF
COUNTY OF ��
affirmed) and subscribed before me of
S orn to (or affirmed) and subscribed before me of
sical Presence or online Notarization
Xi(or
day of 034 q M °+�) er 2020 by
Physical Presence or Online Notarization
this 3- day of - , 2020 by
hck-V 4` -1'fiZ-f
M C.Lr`r, I� r•
Name of person making statement.
Name of person making statement.
Personally Known Y_ OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
c
(Signature of Notary i ate t W&"dRorwa
{Signature of Notary - a e o 1.a
Notary Pubec to of RwWda
Jennifer I ui r
�Jaivillor I Ayuier 399075
Commission No.
Commission No. Myc,=ui G 339s7f
eS 0&29aO23
REVIEWS
FRONT
ZONING
SUPERVISOR PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 5/6/20