HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MIDST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1�. �' �� Permit Number:
[LUC E
RECEIVED
a ° _.. Building Permit Application DEC 6,9 2010
Planning and Development Services ment
tting Dep t/
Building and Code Regulation Division Commercial Residentiq ,„Ney
2300 Virginia Avenue,,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:QJ2)462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEME1NT LOCATfON .
Address: 005 'Ri vesL 13 . "p+Chi nS(y-) _16Qnd. NI '0A G 4 q
Property Tax ID#: 142 5- 56(V C)b 13- (j a 0-t Lot No.
Site Plan Name: Block No.
Project Name:
LED"DESCRIPTION OF WORK a
f
2m0� f�P p1 CA,�_ �xl ti no
YLin+ E=t�-1,rL A C�� Ourl New Electrical Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMSATION " r
�w
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank —Gas Piping _Shutters �Q Windows/Doors _Pond
_Electric _Plumbing _$prinllers _Generator _Roof Pitch
Total Sq..Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ a4 op .00 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE CONTRACTOR
Name C CEO\yn -\A t�'-p beck Name: _De6 n ",POLACQ
Address: aa5 R►veg- a1y_ I ;+ 13 Company:"rrPmIQ.0G1(1"P(1ff(A cC1(1 0 ' R�
City:L1j Ach%r)scr, Js\cLr_, State: Tq- Address 1-IAo Offle11h0.fIP.elr
Zip Code:34g4 a Fax: City: fo?tj Pu?ft'.Q State::TL-
Phone No. Zip Code: Fax:
E-Mail: Phone No �1�-r,�►� �l(o
Fill in fee simple Title Holder on next page(if different E-Mail Q ,
from the Owner listed above) State or 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.
s
SUPPLEMENTAVCONSTR'UCTION.LIEN .LAW;INF:ORMATION:
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.
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 lende n attornev before commencing work or recordi ur N tic f Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA ]
COUNTY OF 6 1 !'it.�-c•-L COUNTY OF
Swor o(or affirmed)and subscribed before me of Swor o(or affirmed)and subscribed before me of
P s�ical Pretence or Online Notarization Physical Pres a or Online Notarization
this day of IJe�� ..ors .2020 by this����lY""YYY day of e N-f o cT 2020 by
o�
Name of person making statement. / Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification ;�
Produced D L— Produced D
Ln d -
(Signature of Notary ublic-State of Florida) (Signature of Notary Pu lic-State of
Commission No. �(� 23 ( eal) Sion No. O Z ,� Notary Public State F a
czoz/sLico sa�! 3 � a I)Colleen Sue Haye
6zLI z JJ uo!ss!wwoo AW My Commission GG 8
Se�!3H 2n$Uae1100 Expiros 03/t6/2023
epuolzl+ s1®1s oii4nd MNION
REVIEWS FRONT Z VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.5/6/20