HomeMy WebLinkAboutBuilding Permit Applicationcan aCh — �l'c��) Sl t� 7 7,7_- 44(1;-7
All APPLICABLE INFO MUST BE COMi-«'r ED FOR APPLICATION TO BE ACCEPTED (�'
Dater ZD Permit Number: b�e
RECEIVED
OCT 0 5 1010
Permitting Department
Building Permit Ap lication St. Lucie County
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:
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aP,ROIMPR01/EM
OR NTE OCATION.
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,ddress ZZS' S, 1,#)re✓t0ooc-( C12, L(yit zsza icy, r.%/,
Property Tax ID #:
Site Plan Name:
Project Name:
da6�a ode Lot No.
s sec. it �h�✓�i122 (���%"Z2�b�v Block No.
fee /0 e-4S li v wrec /
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
_ Electric v P umbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction:
Sq. Ft. of First Floor:
Windows/Doors Pond
Roof Pitch
Utilities: —Sewer _ Septic Building Height:
Address: 22 , W CI tiQ i/up, 222t�t;
City: — I&W— Stater
CONTt�ACTO t g .
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Name: .DAM C-L %DJfg1kD0
Company: 6 e.& -1 a to,u a0h,5/, 'ry l-,
Address: l`/S 64-4Ngd4Sf
City: q, Stater
Zip Code: Fax:
Phone No. %'12 S'2.`d ��y�
Zip Code: 3YIYy Fax: 792- 4ri-5" 6r6 / 17
E-Mail:
Phone No_77Z 46 Jry��
Fill in fee simple Title Holder on next page ( if different
E-Mail d Q LD l--4 i &0A) r b j ° d o
from the Owner listed above)
State or County License e RC o i 5!5' 2,.5'
vawa Uwnau ucLwn 15 LaVU or more, a IMMUKUtU IVoiice oT commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name: f
Name:
Address:
Ad ss:
City:
City: State
City State.
Zip: Phone
Zip Phone:
FEE SIMPLE TITLE HOLDER: _ N licab e
NG COMPANY: Not Applicable
Name:
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Address:
re s:
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.
Luc' County and posted on the jobsite before the first inspeaicin. If you intend to obtain financing, consult
wiyi lender or an attibrney before commencing work or recc(rdinR vour,Notice%bf Commencement.
of Owner
as Agent for Owner
x
STATE OF FLORIDA STATE OF FLO . ,—
COUNTY OF ��-- 3COUNTY OF o�-� �t
Sworn or affirmed) and subscribed before me of Sworn to or affirmed) and subscribed before me of
_L,f�hysjcal Presence or Online Notarization ysical Presence or Online Notarization
thi y of ` �. 2020 by this day of p r , 2020 by
l 1 �I t—'W 1\ rn\�v
Name of person making statement. Ili Name of person making statement.
Personally Known OR Produced Identification
Type of Identi ion
Produced �� � 5R
Personally Known O Produced Identification r�
Type of Ideptificiabon 1
Produced U�C� VevS
(Signature of Notary Public- State of Florida) (Signature of Notary Public- State of Florida )
Commission o�G"'rr�,, KRISTIE F• ��PDublic KRISTIE F. MIR
iorida - Commissio NQu�"'��,,
Commission # GG 197974 a°. 4n; ida - Notaty'i�t7 lic
My Comm. Expires 03-24-2022*®�_ � Commission # GG 197974
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