HomeMy WebLinkAboutBuilding permit appl 6c
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 Permit Number:
Q RECEIVED
Building Permit Application NOV 18 2020
Planning and Development Services
P�rm itting Department
Building and Code Regulation Division Commercial Residential (��r ,,,�;P C"Inry
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772)462-1578
I
PERMIT APPLICATION FOR:
C4- ;Ie
PROPOSED IMPROVEMENT-LOCATION:
Address: L) A O 14r f( o(J4 cwre D Eno- p"f ce. �(,
Property Tax ID#: 114 15 " 70/- (0 0 6 U Lot No.
Site Plan Name: 1 S lAA Block No.
Project Name:
DETAILED DESCRIPTION-OF`-WORK .
Q�� P slime ROOC Ct,&A NO LJ R,.Dp
Double
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFO,RMAT(ON
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 r-nd Roof Pitch
Total Sq. Ft of Construction: (U 00 Sq. Ft. of First Floor:
Cost of Construction: $ 1 S• 00o Utilities: —Sewer —Septic Building Height:2=510iys
OWNER/LESSEE: CONTRACTOR:
NameKe-w,ne�k I.S144, Name: 11u5i'-ate_
Address: ULAD '.'gbo,),r CwJe Df Company:_S„,�r�sP
City: (-of 'rce State: ' G Address: 9-1 1
Zip Code: 3u qyq Fax: City: N. ,L St Lct"e State: L
Phone No. Zip Code: U 95 2 Fax:
E-Mail: Phone No j2� SO/-�?J 3 .'�
Fill in fee simple Title Holder on next page (if different E-Mail udr av� ,S/a�.a,n (q�ad(®of�•�p��`
from the Owner listed above) State or County License GCG 15 3 1 'o
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.Ll;EN LAW INFORIVIATtQN
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,i consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
na ure of Owner/Lessee/Contractor as Agent for Owner nat re of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF s a-. Low COUNTY OF
i
Sworn to(or affirmed) and subscribed before me of Sworn to(or affirmed) and subscribed before me of
Ph sical Presence or Online Notarization Physical Presence or Online Notarization
this, day of t-'Z\J - 2020 by this_\!k�day of f�)6�i 2020 by
0,W\Qh�� Q� {'�q d\ a%NSTIN hA-V
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
Produced fc k—3D 1 . Produced
i,
(Signature of Notar ublic-State of Florida ) (Signature of Nota of Florida )
� •
DEANN
Commission No.Cb�- e� NAMgRIEGNENS mmission No. �� `_ 3 `" GlvErus
.. _ MYCO
MY COMMISSION#GG 022023 EXPIRES:1 ION 022023
% 0 o.J.q;:••' December 16,2020'
F'•••b09 Bonded Notary Public Undenvrl ars a „ ie nderwrtters
'�Of F .
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