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HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: t "�i�li� Permit Number: �0 `) (r O ` Building Permit Application Planning and Development Services Building and Code Regulation Division Commercial Residential i✓ 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 PERMIT APPLICATION FOR: PRO'POSED.IMPROVEMENT LOCATION: Address: (/?5- cLew ail 0&4ch,.-M 349V /-7d2 Property Tax ID #: y Z - Go 2 " e2 4 SW - o o o f !7 Lot No. Site Plan Name: A4,-,41'& Block No. Project Name: &i4o we 11 ,-DETAILED DESCRIPTION OF .WORK: L I'96,4� !EI LF,diace ���vri cam .zip 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: tz -7o Sq. Ft. of First Floor: Cost of Construction: $ �j�, �� Utilities: -Sewer —Septic Building Height: F2 OWNER/LESSEE. = CONTRACTOR:.:.... Name /&121 GlA- A�iu2u►��,q- Name: /Lj�/�Alft&124 Address: Jo^nr * �� ©GL,;-,esr-7 Orive Company: Address: 22?$6R 5 12 City: 1_].eti� A&AC► State: P1 Zip Code: 5 4aiS?' Fax: City: 'S�' &W State:7`re_ Phone No. '90/ - :7- 3 9 , ZS Z9 Zip Code: 55 W�3 — Fax: E-Mail: Phone No T30 - / % 1;q7z.-ftzg3 Fill in fee simple Title Holder on next page ( if different E-Mail S702MP69rf-C G041A Z. 60141 from the Owner listed above) State or County License GEC, ►Sdt4 nSJ it 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 TITLEHOLDER: _ 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 commencine work or recaf ling vouriNotice of Commencement_ • A'X ti Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA 1 e COUNTY 5� I'm f STATE OF FLORIDA SphV?' kkf' e OF . ucie, COUNTY OF Sworn to (or affirmed) and subscribed before me of Shorn to (or affirmed) and subscribed'before me of A Physical Presence or Online Notarization &dtMbGC S_ Physical Presence or Online Notarization thiso day of 2020 by this-K±tday of W 2020 by )VI Z5't N mozoln4 Name of person making statement. Name of person making statement. Personally Known OR Produced Identification Personally Knowns Type of Identification Type of Identification Udit9i•/90 sendx3 0"'0 �JJ rya Produ ed ZtE9�Z uoissl] law t a •�►ta,a+`� f�V ep!�old to ale1S olignd tieloN >, ,,Signature of Nota (Sign ture of Notary Public- State of Florida ) Notary Public State of Florida Is R ren Ilnper Commission No. Commiz 9342ea Commission No. (Seal) W Expires 0&21l2024 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED nev. :)/ o/ to