HomeMy WebLinkAboutBuilding Permit App All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I-2-1 7 1-,? 0 Permit Number:
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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:
PROPOSED IMPROVEMENT LOCATION:
Address: 2--7Q ILJ Pvr— -- S-F, EL 3 Y r1 �-3
PropertyTax ID#: Lot No.
Site Plan Name: Block No. -7q
Project Name:
DETAILEE3 DESCRIPTION OF WORK:
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LI O l/r r, r 1 - e,�- � , , a
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 1/Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: �j Sq. Ft. of First Floor:
Cost of Construction: $ 17p> / <Y Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: ,rysy CONTRACTOR:
Name �t✓StEi�C� ///£�l?�tf' Name_ /t' A&-rliltfl "" "
Addresss�: 2,70 NC��'t1MIne''' � -Company; A r&- Pllilwbewf �
City: 10Ff sf L✓r-4e- State:l:=(. Address:16 7 5C SOiZY11 k1reM6gef &r
Zip Code:Jgl�8-3 Fax: City: t--t- St !'oue- State: rCL
Phone No. c9,66-1- Zip Code:3 49 a Fax:
E-Mail: Phone No-7-7
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License C—l'C /ql-A alf35
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: 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.
l 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 th jobsite before the first inspection.If you i tend to obtain financing,consult
withAlendw or an attornev bef a commencing work or recordin our N lce of Corn cement.
/Ra f 1��-
Sig ature of Owner/Lessee ntractcir as Agent for Owner Signatu of Contra or/License H I r
STATE OF FLORIDA _ STATE OF FLORIDA
COUNTY OF � 4 La u e, COUNTY Of S
SwpFn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
i✓ Physical Pr nce or Online Notarization P ysical Presence or Online notarization
this�l.day of 2020 by this day of 1 " '/^ 2020 by
ft 4A, 4�r t Ml_ '4 `i v' �C
Name of person making statement. Name of person making statement.
Personally Known Z OR Produced identification Personally Known V OR Produced Identification
Type of Identification Type of Identification
Produced Produced
1
Signature of Notary Pu L�bliFilsri Signature of Notary Public-State of r' DIANE cot
w 141!COTE =:; `_ Notary Public--stat a iorida
>pF = Nota bl�" -State of Florida Cammiss+on k GG E4
Commission No. �_ Cor �[ It GG 9 11089 Commission No. ='�. MY Comm.Expires M r ,2024
ioFss�`' my comet.Expires hoar 14,2024 �9ondtd tfirough National of Assn.
Bonded throe h Nationat Kota Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE -
COMPLETED
ev.515/7-0