HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED'
Date:
Permit Number: _�) V i 0
RECEIVED
Building Permit A�pplicatio ocr`2 s. 2020.
Planning and Development Services � ing Department
St ucle County
Building and Code Regulation Division Commercial Residential 999999
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: C�
Address: 3,1 279 d lip_1G�c�•p(f1 e
Property Tax ID #: �408, 006 3 " a OO - + Lot No.
Site Plan Name: Block No.
Project Name: lWr� or<r
New Electrical Meter
Xzto' CjCLV0 4\a�, CCALY.DoV-11' OA'1 roCAC, /ava_Q-ek
Second Electrical Meter
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:. C) Sq. Ft. of First Floor:
Cost of Construction: $ " ��" Utilities: —Sewer —Septic Building Height: 1
OWNER/L MBEE:
CONTRACTOR:
Name 61 " it"
Name: C i n
o v t-6
Address: ',3& oLw ciy4.
Company:
Address: l5 "
City: � ser,-Pk f-1- a State:'El_
Zip Code: 3 "L 41 Fax:
City: 'lobs —oh
State:-N-C
Phone No. "'Z 7 2 - e3 0 Z- I'+qS
Zip Code: 30 O r
Phone No v
Fax:
-7Q ZCael-
E-Mail: YY\ Lk-8 & C1 VA (A C0Y%-3
Fill in fee simple Title Holder on hiext--page ( if different
E-Mail G�
r0h . Cd
from the Owner listed above)
State County License
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.
DESIGNER/ENGINEER:
Name: OM,a
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: 0('s war
o2 a
Address:
City: 6
State:
-a
City: State:
Zip: •a Phone b0-
26'
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 {esult 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 o e jobsite before the first inspection. If you ,inten.d to obtain financing, consult
with lender or an attorneore commencing work or recording your Notice of Commencement.
C-17
ign-atufger/ Lessee/Contractor as Ag nt for Owner
Signature of Contractor/License Holder
STATE OF FLORID _
STATE OF FLORIDA
COUNTY OF
COUNTY OF
Sw/rp to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
_P&Sical Pres ice or Online Notarization
Physical Presence or Online Notarization
this day of('/� , 20�by
this day of 20 by
e e 4�5ku lmcr-
N e c_ff p rson making statement.
Name of person making statement.
Personally Known, OR Produced Identification L/
Personally Known OR Produced Identification
Type of Identificati
Type of Identification
Produced i ' ' (
Produced
(Signature of No6fry Public-
State of Flori a)
(Signature of Notary Public- State of Florida )
Commission No.
nv a� •.
;=o`" �: AUD "'PHREY
Commission No. (Seal)
MY CO MISS ON #� GG 300817
Po ` EXPIRES: March 6, 2023
_Bonow 1111, Nol2r,
Public Underwitem
REVIEWS
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PLANS
VEGETATION
SEA TURTLE
MANGROVE
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REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20