HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED _
Date: RECEIVED Permit Number: I
_ NOV 0 6 2020 AwnoD aion-i 'is
auawaaedaa 6u!n!wJad
e Permitting Department
Bull-diAguPermit Application oaoi 9 o pure
Planning and Development Services / 43AI 09'8
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: 100.00 S . OC, ea In ' r . 0n i -� 110 -7 lens en 11-eac,VN 3 N q 5'7
Property Tax ID #: g5_11— 5_17 — 01l4 000- 0 Lot No.
Site Plan Name: learn I r>e z— RQ S!6%ne a Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
i 'r
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 _ Windows/Doors _ Pond
,Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: to a .3 Sq. Ft. of First Floor: 10 01,3
Cost of Construction: $ a QUO . ti 8 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Aolo Wo 2aMirez
Name: Edward �S�n
Address: 10& C20 5 . C9Cean Or. UO UT W to
Company:_ E.
City: yerl se6 ae Q &h State: FL
Zip Code: 2!4 15-7 Fax:
Phone No.
Address: 5a 0 7 0a L Z, lee C' e r
City: f Y/e/"Ge State:E1_
Zip Code: 3Yg.5-/ Fax:
Phone No 051 /) ysa —s9//
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail �� L
State or County License -C / 0
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
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 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 commencing work or recording vour Notice of Commencement.
Signature of Owner/ Les ee/Cont actor as Agent for Owner
Signature of Contractor/Licens older
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF ;4 _ U( i Q
COUNTY OF
S4 . Lkk to
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and
subscribed before me of
d Physical Presence or Online Notarization
Physical Presence or
Online Notarization
this *P of M �o yn ln.nfr 2020 by
this � dayc�of �! 0y� �1/►
b 2�t , 2020 by
\day
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Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification V
Personally Known
OR Produced Identification
Type of Identification
Type of Identification
Produced OPLtt
Produced , L'�
4�►� Notary Public State of Florida
LAIX LP vi N Mona Leon
Notary Public State of Florida
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Mona Leon
(Si nature of Notary Publ - f ¢ft018120/2022
(Si nature of Notary Publ
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Commission No. (42-3h 03 (Seal)
Commission No. GCa23CS
ati
(Seal)
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