HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1110zoo . Permit Number: 0 a
RECEIVED
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Building Permit Application permitting St. Lucie
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:A,�
PROPOSED IMPROVE LOC T ON:
Address: %3D�2 �'�
Property Tax ID #: �.3 �� (g �) - �� ) - ' �. Lot No.
Site Plan Name: Block No.
Project Name: Q
DETAILED DESCRIPTION OF WORK:
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New Electrical Meter Second Electrical Meter
[—CONSTRUCTION INFORMATION:
Additi nal 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: JUL-
Cost of Construction: $ 15r?00
Sq. Ft. of First Floor: !7Dd
Utilities: _Sewer _Septic Building Height: NO
OWNER/LESSEE:
CONTRACTOR:
Name 7stm f,r�."e
Name: BTU w 0,.
Address: %300 Re,4T cal"
Company: �1�-� �'LeS�c%-►`Itiw� U-02
�1
City: _1 OTI s u� + )-ta State:
1
Address (ac(�- Sw & � In
Zip Code: 154!)K& Fax:
City: C d+ 51. A`f I-16 L State:
,
Phone No. 7 4 �2--i19- 53
Zip Code: '54 N'3 Fax:
E-Mail:
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail
from the Owner listed above)
State or County License C)CIDLAab9
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 LIEN LAW INFORMATION:
DESIGNER/ENGINEER: t _
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: L'5-�
Name:
Address: S `' E
t'd
Address:
City: •�'L
State:
City: State:
Zip: ' Phone '77.A_—
S-o5?c>_
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, consult
with I6nriar nr an gttnrnPV hafnrP rnmmenring work or rerordine vour Notice of Commencement.
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Sig ture of Owner/ Lessee/Contractor as Agent for Owner
Signature of Conttracctorr//License Holder
STATE OF FLORIDA
STATE OF FLORID
COUNTY OF P • Lti�
COUNTY OF
worn to (or affirmed) and subscribed before me of
SVrn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Presence or Online Notarization
this :.2�L day of . bi02020 by
this _:L day of 2020 by
_VQ'i 1 b kA) AA1A r-e.
i h k/) l a e,
-DaJ �
Name of person making statement.
Name of person making statement.
✓
Identification
Personally Known OR Produced Identification
Personally Known OR Produced
Type of Identify n
Type of Ident o
Produced
Produced
(Signature of No - atA(d6 ' IP
.4A <.•; GG 30081 ..,
Ik
(Signature of Not
P:'/..: AUDREY B. HUMPHREY
MY COMMISSION
Commission No. *' �_ XPIRES:Q �p 2023
Commission No.
\pSPPY
=.: c* MYCOMMISSWj G300817
I'rFOF F4Y`.•� Bonded Thru Notary Pub rc Under;+at=;L ;
"".::,
; Zb o';: EXPIRES: March 6, 2023
rF UP.
f Thru Notary Public Underwriters
.... ,^�
;.• Bonded
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/26