HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED _
Date: Permit Number: _e96i i 0
RECEIVED
O
Building Permit Application OCT 212020
Planning and Development Services Permitting Department
Building and Code Regulation Division Commercial Residerltial5t, Lurie County
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION ",�Lp(,, 3. V1�IS.
Address: 11600 S% 005EkV DR J_&/54e2tJ /3EXQW 3 gl —I
Property Tax ID#: t&17. -701 002)o000 G Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTIOLOF =WORK . t 13Lp6
Cd uCUrC 05TO nOMY Cf2MfiJQU s 17
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 _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ S.,0&a . 190
Sq. Ft. of First Floor:
Utilities: —Sewer _ Septic Building Height:
',OWNER/LESSEE
CONTRACTOR:
Name V UA9 XL Sot. &s3oC �C
Name: o 6cT TA ft
Address: 1600a ,f 6cagws QC
Company: $7fl U CTuRE
Address: 24 24
City: T` NSExr "CA State: _A5�`
Zip Code: 3 M r7 Fax:
City: D F_EC.EJbJ3 EC State:--25-,e_
Phone No. 71Z 33Z_ q1 7 z
Zip Code: Iq 2 7 3 Fax:
E-Mail:
Phone No 772 %, r A4 3f
Fill in fee simple Title Holde on next page (if different
E-Mail cRp I . Co nq
from the Owner listed above)
State or County License C C.C_
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.
SUPPLEMENTALCONSTRk1C�TI
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ON LL`ENttIAA, /#INFORMATION
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DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name: St1aKEl� >cuu6tw rEF/�►Nv
Name:
_
y
Address: /U Af -9,QLr ar- flw.30�
Address:
City: Lay A wo �-w State: %4L._
City:
State:
Zip: f _ Phone &jj S'S,s� .3-494,
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 gr andcovenantsthat 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
witb.lendeir or an attornev before commencing work or recording your Notice of Commencement.
-A
as Agent for Owner Signature.of Contractor/License Holder
STATE OF FLORIDA ICOLINTYOF
STATE OF FLORIDA -
COUNTYOF S� X0c/ S7- Lucre
Swor to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this JIL_ day of DGWO C . 2020 by
Sv s an +E 14 ct 11 /7te
Name of person making statement.
Personally Known V-taOR Produced Identification
Type of identification
Produced
ature oT"NOTT otary Pubaicr $'a of Florida
hannon O'onnell
Commission No.ommin' �d)248323
Expires 09/13f2022
REVIEWS
RECEIVED
COMPLETED
Swory-to (or affirmed) and subscribed before me of
t/ Physical Presence or Online Notarization
this J I day of Ag!VSft , 2020 by
69ka��W
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
Notery Public State Of
Shannon O'Donnell
i�ly-6arptaiubn GG 2
Expires 0gl1312022
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COUNTER I REVIEW ZONING I SUPERVISOREVIEW R I REVIEW PLANS I VEGETATIEV EWON I SEATURTREV EWLE I M EVIEWVE