HomeMy WebLinkAboutBuilding Permit ApplicationAll APPI ICARI F INFn MI1ST RF CAMPLFTFI] FAR APPLICATInN Tn RF ACCEPTED
Date:
Permit Number: d� `-' 10
91ro L UC M
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Building Permit Application o a
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 It�`/IPROU MENT LOCAT,I'ON ;��� �� �� _�'°�pG k��� /�� CpG���►i �� � �°�`'� f' ` � �«'
Address: 1100o S CCE'AN ,7k, 3Z*15 i:PJ 39*M 3K9577
Property Tax ID #: qrl 2'7o I O000Ocoo ( Lot No.
Site Plan Name:
Project Name:
EC7 H,1a IC L
New Electrical Meter Second Electrical Meter
5"2{f 5 c sfyim 5i,
Additional work to be performed under this permit —check all that apply:
Block No.
_Mechanical — Gas Tank —Gas Piping _ Shutters _ Windows/Doors — Pond
_ Electric _ Plumbing —Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ !_;i�r�_F� _
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
rOWNER/LESSEE }4r yr , ���
uC C\r YF a a i G-£r'f,.a -.,.. s�' . �^_ . 't..R kf
CONTF4CTOR
d CuY., Tf..-1.. = ..k?.il •K� 4.•�s
NameV-.ue ya Sot, ASSvc. ANC .
Name:1o 0 S
Address: /loop S. ocenw 02
Company: 4fXVeTvjU-' "CON
City: ;IQS&V 841IC-*1 State: KL
Address:F.—D. 24 2
Zip Code: '5DV Fax:
City: WEFCHc F r Stater,_
Phone No. 171L 3;2 4-1 t7 L
Zip Code: 349 73 Fax:
E-Mail: toeded G3 0 jamt/ - -cO r1j
Phone No 772 Z/ S ffG 3/
Fill in fee simple Title Holder on next page (if different
E-Mail &cydyr-c oqQ !—Dd , CD JM
from the Owner listed above)
State or County License 1-76C 1)(01 �0 3 S
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.
M Y t '�.
SUP,PLEMENTALCONSTRUCTIO..LIEN LAaIU INFORMATION
S 4 � i
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: 19V0vk= 8M6at/f 1W6
_
Name:
Address: ju N. r—J- Z4 ." gyr
Address:
City: Stater
City: State:
Zip: %'S(.�4ro Phone A �8f; �Ggce
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 Ipnelpr nr an attnrnpv hpfnrp r_nmmencinE work or recordine vour Notice of Commencement.
Signat a of wner/ /Contractor as Agent for Owner
Signature of Contractor/License Holder
STAT OF FLORIDA
STATE OF FLORIDA
COUNTY OF !C; LlG/rO
COUNTY OF S"� Z✓C�.e,
Sworn to (or affirmed) and subscribed before me of
Swofrf to (or affirmed) and subscribed before me of
✓Physical Presence or Online Notarization
✓✓ Physical Presence or Online Notarization
This— L day of D��� , 2020 by
this � day of d g . 2020 by
51esgtt HAII M /
/Pe Z�
Name of person making sta ement.
Name of person makingstatement.
7OR
gs
Personally Known Produced Identification
Personally Known !� OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Nota
Cigna ftroMcRary Public
Notary Public State of Florida
Commission No. +P Shannon 9"-
K�P)ry Public State of Florida
Commission No. BggfiO'Donnell
l0
08113/2022
o scion GG 2aa323
res De11312022
O Expire
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Kev. b/b/LU