HomeMy WebLinkAboutToombsPermitAppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
!1C(,-0sE - =
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: QA-P-cx4
PROPOSED IMPROVEMENT LOCATION: qlD?- (-,
Address:
Property Tax ID #: Lot No. 2
Site Plan Name:_ Block No. C
Project Name: combs RL- 0-cX4
1xY 1uf-ua-L&&ii y avc-, Ui�.3l[ "I daL V411 e-v rvi.e.ket 6 a t Pd .o (4-)de %-!a it
l eacP I ds �ccC C� W'07fS * C0d,t' � c� 1� CL�n wt& .�aOk to Q e� 4-c� cc t�
New Electrical Meter Second Electrical Meter
I CONSTRUCTION INFORMATION: I
Additional work to be performed under this permit -check all that apply:
—Mechanical _Gas Tank —Gas Piping
_Electric — Plumbingc� —Sprinklers
�
Total Sq. Ft of Construction: 4- fl- Le
Cost of Construction: $
_ Shutters _ Windows oars _ Pond
Generator
yRoof —lam1 , Pitch
— _
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name Q'Drma-n—Foc>rnl0S
Name: (W YL)V1 C�3 ('-
Company: P71Dft&C(- Sic.e Q 2 "ZS
Address: GD2 6q'-1 e. (
City: La.(-C_. c State: F1
Zip Code: )tJSZ Fax: N -ftCity:
Phone No.`-1-12-�1 - l()( ZO
Address: 15b-"I �S. ✓"JvC11— q(tr %'
'R,+S' State:
Zip Code: iri - Fax: r9
Phone No --77T- , - CO2.1 2,(o�j
E-Mail 04i c:z c)
State or County License ACC- 1 63I Ztpd-
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
•...'.-- I u �aW%j VI Iiurr, a RcwlwCv Nome or Lommencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
C SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: — Not Applica
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: — Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
_Not Applicable
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 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 lender or an attorney before commencing work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA l
COUNTY OF
Sworn to (or affirmed) and subscri ed before me of
Physical Presence or Online Notarization
this% day of —)Cep 2020 by
ICJ opwa4A I Z?n
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced ,'(_ _
re of tefitractor/License Holder
STATE OF FLORIDA ci
COUNTY OF i Ci,%�
Swor9A<Or affirmed) and subscribed before me of
IP�h,�,sical Presence or Online Notarization
this day of i'SQVe 1 2020 by
pj�_Py_ro/l
Name of person makings-ta/te�ment.
Personally Known OR Produced Identification
Type of Identification ;
(Signature of Notary P bTi�!;t - e %W90djQState of FWda
(Signature of Notary Public-
t . a Public state of F
amela Jones
a4 Pamela Jones
Commission N
My coma 11yy� GG 965470
Exviresll�i66 °�►202�
Commission N
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