HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
CauL�
P a ,c lZ t' uJ - 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: R 1 n
PROPOSED IMPROVEMENT LOCATIO :
address: I i D 4 C- d cie L l P K ct - Pv;e -t F erc-v- FL ?v9,k Z
Property Tax ID #: Z `'j Z 1 - Fii1 z - 001 1 — 0 0 C _ _3 Lot No. /f
Site Plan Name: Kz I t h Ro S r d en c Block No.
Project Name:
DETAILED DESCRIPTION OF WORK: I
- N00
0 d, ri (f�q SvS f e
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
_ Electric _ Plumbing _Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ A; 1 q 0 OQ
_ Generator
Sq. Ft. of First Floor:
Wiinny�ows/Doors
�' Roof
Pond
Pitch
Utilities: _Sewer _Septic Building Height: i1 4--4-
OWNER/LESSEE:
CONTRACTOR:
Name t4,,i+k Ye I rn Gl
Name: 01) 1 Ce 13 LQ r a
Address: 170q 5dgCli4lc Kd
Company: f-al RoVi' Ssje^s riP- �
City: ar` f' Pi RV C-P _ State: F L
Zip Code: ,3yq*y Fax:
Phone No. -7 '7 2 -872- -9-0 36
Address: 31 `i o S r A4 �/ 4- ,
City: S$Var4- State: 1=L
Zip Code: 3 5 9 9 -7 Fax:
Phone No Y7 2 -k 7 - Pa eU
E-Mail: 0.CCoun 1
���nG
Fill in fee simple Title t4 [der on next page ( if different
from the Owner listed above)
E-Mail q len a it. ( f /$S ne
State or County Li se CC(_ .1 33 7 3 ja
iT value oT conarurnon is /t uu or more, a KECUKUED 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:
Name: � C' I M- Ci flf' '
Not Applicab-le
7
MORTGAGE COMPANY: Not Applicable
Name:
Addres C.'. _ '-:__"'V
t C
Address:
City_
Zip: c Phone /
�Statet
22 - —'�_(7
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
Name:
Not Applicable
BONDING COMPANY: _Not Applicable
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 Countyy 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: Yourfailure 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 recordin f Com cement.
__. ,.
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Signature of Owner/ Lessee/Contractor as Agent for Own --Signature
of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF i ti �;�r - -; N
COUNTY OF mar "t1 n
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
i/ Physical Presence or Online Notarization
Physical Presence or Online Notarization
this 22L day of AV 0L�E'�%LL',, .2020 by
this �, dayof Nov6Mb2/ ,2020 by
Velma 1�2�frt
uI LarG
Name of person making statement.
Name of person making statement.',.
Personally Known OR Produced Identification r�
Personally Known OR Produced Identification��
Type of Identificati n
L�GC-r�-S�
Type of Identification
Produced s/iJ'E�-�+5
Produced
(Signature df._Notar Public- State of Flor a=�� , Notary Public
-
5(igfialtlide f Notar a F ri' nJAFFE c lone
(1 ti` ^ c,_�y Conr�issio
Commission No. la - ( IC t ea,.7•-- ` My Comm. Ex
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5 6 20