HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
COUNTY
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial X Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR: Gt//V-o E 0av2
PROPOSED IMPROVEMENT LOCATION:
Address: /D/ S Z S O c�x}s�/ T�rL �l� 7L1✓SE7v �tlt
Property Tax I D#: y S 00- 503- 00/ q - Q�p y Lot No.
Site Plan Name: MG-p0,4t,o Block No.
Project Name: M C- 0- )
DETAILED DESCRIPTION OF WORK:
/vn o,/ ��2 L�-��O�il t�i fro✓�1J�t�,esG; 6_3(r s iri ni 6 P,47k .c
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: Sq.
Sq. Ft. of First Floor:
Cost of Construction: $ e&oc) Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR: J Name /(ri/Dy'�c.p V Name: 'Yl C414 Z ���'�G✓s�!"
Address: /O/ S Z 61C&-,t/
Company: �,L L.( C-
City: )f-2v5A-A,, ?L State: r2- Address: )'K S'Z1
Zip Code 7YgJ—L Fax: City: ��L State:�L
Phone No. (_573) -774 -- 5 S-S Zip Code: 7L1ti _Z Fax: n,A_
E-Mail: CMGDD& J a ;Iyohae 0AoL_,Q,.-, Phone No 1?2- L0 -OS`60
Fill in fee simple Title Holder on next page ( if different E-Mail AA LC, L-LC e f�oTcv-.41Agi L, GpA--
from the Owner listed above) State or County License CGC I
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.
$0PPLE-11r7ENTAL CONwy
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: FL0✓U✓A- AkAMAIVam Nf- Name:
Address: 574jo-1 5 Svc i-e 2-yD Address:
City: 71tW19 State: _Pl-- City: State:
Zip: 5,36os Phone ( 3 "37y— Avo3 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, alls, signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failur ecord a Notice of Commencement may suit in ing twice for
improvements t you pr . A Notice of Commencement must b ecor the public records of St.
Lucie n y p e o e jobsite before the first inspec ' I ou i to obtain financing, consult
r a efore commencin work or re di our a of Commencement.
ign ure of Owner/L ' e ractor asAgent or wne gnature of Contractor/Li nse Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF N\Ca r i , n COUNTY OF 06 Y-A i rl
Sworn to(or affirmed) and subscribed before me of Sworn to(or affirmed)and subscribed before me of
✓Physical Presence or Online Notarization ✓Physical Presence or Online Notarization
this IL day of DC C-c m h — 2020 by this!A- day of D'Ce r n Yes'' 2020 by
Name of person making statement, >!". ;; ame of person making statement. "'•
Personally Known OR Produced Identification ersonally Known ✓ OR Produced Identification
Type of Identification '"' ype of Identification
Produced < roducedMo
Nk Lox"I OJ(
m �
(SignatuJ of Notary Public-State of Florida ) Signature of otary Public-State of Florida )
(1 �
Commission No.GG 4A. IC (Seal) � o � ommission No.CG> 9 a;)W 1 (Seal) N
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m
REVIEWS FRONT ZONING SUPE JILANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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