HomeMy WebLinkAboutApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12 I0 20 Permit Number:
C O C_Y
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: J V I / V1_': DJ .JAf (> S lZoAj]
Property Tax ID #: 2 Lf 7- cj - 1 21 - C7 t7 2Z _ 0 np Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
Block No.
Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
—YElectric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 2 0 0 . coo
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic
FO—WNER/LESSEE: I CONTRACTOR:
Name C-Fltr+lDr�ce S1,,NT-t Yo't t��
Address: S 0 17 O►- 0 e-DW ✓kr-0 KO
City: Fr Pr�F C. J � Sd l State:
Zip Code: 3 4 Ci Q 1 Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Building Height:
Name: >Cdc.-�'lAr
Company:
Address:
C-,i-
City: r-P
011cr rr,P-
State: r-r.
Zip Code:
3(44 SI
Fax:
Phone No
?�-(, l
- Wei
E-Mail l; ,
S An j T1?
d &e-14" lq
State or County License
"13
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,SOO or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
^ Not Applicable MORTGAGE COMPANY: — Not Applicable
Name:
Name:
Address:
Address:
State:
City:
State: City:
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 noyrepresentation that is granting a permit will authorize the permit holder to build the subject structure
structure. conflict with
with your Hlome Owners Association iandrreview your de d far any r strict ons at wh ch may ct apply obit such
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 lender or an attorney before commencing work or recording your Notice of Commencement. i
Signature of Owner/ Lessel/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTYOF .ST- i;Q c-� e-
Sw rn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this 10 day of 00 e_P wi3er" , 2020 by
Name of person making statement_
Personally Known OR Produced Identification k-
Type of Identification
Produced of, Li C
Notary PUD6c State of Florida
t �1/1G1 P /il/1 �JJ: Mona Leon nn 230893
Signature Contractor/License Holder
STATE OF FLORIDA
COUNTY OF S,T" I_ Q t--t r
Sworn to (or affirmed) and subscribed before me of
V Physical Presence or Online Notarization
this _(,Q_ daylof ae-G--&%p ,- , 2020 by
G�e.larJ S*-%L-r-tit-
Name of person making statement.
Personally Known OR Produced Identification,
Type of Identification
roduced D.(. L,V
�Notary Public Sala of Fldtoa
(Sig azure o otary Public-tn�orIDlprj s 06n=022 Signature of Notary PublicMV
i�i ro ,,,w GG 230893
■gref o6rM2022
Commission No. ZS6 (Seal) Commission No. Z30
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER I REVIEW I REVIEW REVIEW I REVIEW I REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
MW". AM