HomeMy WebLinkAboutRegina Ave PermitAGI CC' IO -
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I0l d6L/� Permit Number:
49T. [LUC�O[v�/
L5 a o a o c�:a
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:
PROPOSED IMPROVEMENT LOCATION:
Address: 117 1 �t e�0
Property Tax ID 7t: 3L4 03r'Soj.. NEI -OR FS, Lot No.
Site Plan Name: Block No.
Project Name: 5
DETAILED DESCRIPTION OF WORK:
`QMOvc ('xiShn� lo(Ld�n a v ft tit0l ns tOl Cdx I V or
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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 V Windows/Doors
_ Pond
Electric _ Plumbing _ Sprinklers
_ Generator _ Roof
Pitch
Total Sq. Ft of Construction: 1 ✓ Oo
Sq. Ft. of First Floor: ( �?o J
Cost of Construction: $ i 500 Utilities: V Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Al
Name: sr i 1 ii ln.�r,,,) ��1
Address: Nj7Kq �ee�
Company:_Dj RfS�Ci+n>) iu 1
LI c
c
City: J State: r�
Address: -7o5 S qqA, St
Zip Code: Fax:
City:—Z2N Z6-1
State: F�
Phone No. 722'307—OG
Zip Code: 5�j9z)7 Fax:
E -Mail: 41(A
Phone No -7 7P--93 7 —1 �y 9 -
Fill in fee simple Title Holder on next page ( if different
E -Mail 6u Cel &,}i,, P ��f(`1kr
I co,
from the Owner listed above)
State or County License C-\50;0,9(2
q
value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
N, U �X
DESIGNER/ENGINEER:
Not Applicable MORTGAGE COMPANY:
Not Applicable
Name:
_
Name:
_
Address:
Address:
P ca Presenc Online Notarization
City:
State: City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY:
Not Applicable
Name:
Type of Identification
Name:
Produce
Address:
ELLEN VAUGHN
_ state of Florida -Notary Pu
Address:
Commission # GG 9
City:
(Signature of Notary Public faf ,; ori Commission Expire ( nature of Notary Pu i -
October 22, 2022 Y VAUGH Public
City:
ELL
.P Florida -Notary
Commission No. �. State of GG 270079
ires
Zip: Phone:
C "'oemy. x
= My Commission2 22 _
atober 22
Zip: Phone:
u WNER/ CONI RAC TOR AhFIUV IT: 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 1 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 IPndpr nr an attnrnpv hpfnrp —m—ring urnrlr nr rarn-linan—ir KIntirn of r—an—ant
K � A �,JA-
N, U �X
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature o Contractor/License Holder -
STATE OF FLORIDA SL
COUNTY OF((
STATE OF FLORIDA
/�Y
A(
COUNTY OF 4
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) an4Aubscribed before me of
P ca Presenc Online Notarization
_ P y ical Preser c Online Notarization
this day of 2020 by
this day of 2020 by
C"'
((ei-
elitt0 W a
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
Produce
d iced
ELLEN VAUGHN
_ state of Florida -Notary Pu
lic
Commission # GG 9
(Signature of Notary Public faf ,; ori Commission Expire ( nature of Notary Pu i -
October 22, 2022 Y VAUGH Public
Commission No. Seal
(Sea])
ELL
.P Florida -Notary
Commission No. �. State of GG 270079
ires
C "'oemy. x
= My Commission2 22 _
atober 22
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
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MANGROVE
COUNTER
REVIEW
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DATE
COMPLETED
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