HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO /MUST BE COIF:. -.rED FOR APPLICATION TO BE ACCEPTEC, ,�J +ry-�
Date: / V . 5 1 Permit Number: ��� 0t
RECEIVED
OCT0 5 2020
Building Permit Application Permltting,Department
Planning and Development Services 5t. Lucle County
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: .15-W A/W 8UJ'fD11b(d,�11 `t',r
Property Tax I D #: LiL101 % - gIS-- OOSy-- 000 - 67 Lot No.
Site Plan Name: L_ or-),, h4r do Re PLG%nc e, Block No.
Project Name: L On-1 bGtrdo ge 0"de,-,ee
DETAILED DESCRIPTION OF WORK:
/% wr
New Electr I Meter Second, Electrical
r
CONSTRUCTION INFORMATION: I
Additional work to be performed under this permit =check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
�lectric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: -7 3 4' Sq. Ft. of First Floor:
Cost of Construction: $ 2 �'(� Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 1e hn L one 640-d o
Name: t':OfWad -d
Company: E-. Srn i)_6
S M i 147
Cle r--h-1 G
Address:: 15 yy N W t3j4'f"7'Dnbasl, Cir
City: Pa �M C I State: FL
Address: Sa 07 O a
A
k/av d /a ke e 1 /'
Zip Code: 34190 Fax:
City: FT Al rc e_
State: FL
Phone No._ 365) % jq_ 5-6-gr
Zip Code: 3ygSI Fax:
E-Mail:
Phone NoT/) 4(5d - J9// 7
Fill in fee simple Title Holder on next page (if different
E-Mail 8. im i �% SeryIG
es 00 Q ate . CoM
from the Owner listed above)
State or County License
EC 13ya 4 11_13
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 installationhas 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 atternev before commencing work or recordine vour Notice of Commencement.
Si ture of O r/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA ''
STATE OF FLORIDA
COUNTY OF
COUNTY OF
jorn to or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
K Physical Presence or Online Notarization
this day of -6244. 2020 by
this ZZ day of (oPry 2020 by
C�v,�-1-�► �w�c�Qn�"
Ed S
Lt, oorJ
Name of person making statement.
Name of person making statement.
Personally Known X OR Produced Identification
Personally Known OR Produced Identification V
Type of Identification
Type of Identification
Produced
Produced rJo.
.yFr Notary Public state of Floride
(Signature of Notary Public- State of A ida L.
of Notary Public- t ort ip1mmission GG 230893
�6$�1 °ia1YP�"'•. CYNTHIA BE
�� Notary Public - St
GENER an Expires 08/40I2022
tC6frpAas 6623M
Commission No.
` Commission N
n No.
H 025801
. .... My Comm. Expires
Jul 30, 2024
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