HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �'k.1 51� Permit Number:
RECEIVED
an
Building.Permit Application OFr• 15 2020
Planning and Development Services Permitting 0 rtment
Building and Code Regulation Division Commercial Residentialst. w County
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:��lo��ti2�P�Ac� O & -Sr-/�✓6 61�7 q//� 0s}�cAl�7�
PROPOSEb IMPROVEMENT LOCATION: 03 d1a /+1C /4'tv-
/ GE'
Address: O 3 �d/��L A t
Property Tax ID d: 3W — .5/D — D/3/ — 0 Lot No. !
Site Plan Name: AiAS1AjA- Block No.1
Project Name: O/3`7Z7� 'S/ )F7JCL,-
DETAILED.OESCRIPTIOWOF WORK:
��to�� c�n�wCc C-X/S7�a/6 X7a •4- A-Z, a -
W !TN- H/A-11/ DAD Yo /K P AcT /L-A-1" AKf}22•1V0A*-18'-a7aS%
lU AIC PA N Ez A*rr.�
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit—check all that apply: / U
_Mechanical _Gas Tank _Gas Piping _Shutters V rs _Pond
_Electric _Plumbing _�rS�prinklers _Generator _Roof Pitch
Total.5q. Ft of Construction:/ 11 '.5Q t Sq.Ft.of First Floor:
Cost of Construction:$ /� Utilities: —Sewer _Septi Building Height:
OWNER/LESSEE: CONTRACTOR
Name /N / Name: G- 6Mtj
Address:—Jo Address:-Jo3 O LA-te A tt Company:A/1 /14rD I a " So FL
City: .i �/L— state: Address: S S h/ 6. C -
ZipCode: 3419, Fax: City: nm A4tJQ state:L-C_
Phone No. — a Zip Code: 33040 Fax: I fi^,
E-Mail:—I-rtj hpji' J l 6R /c° f
Fillpage(
�sSD
in fee simple Title Holder on next page(if different
from the Owner listed above) State rr County License' CJ'3e_ d-3 3
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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.
l 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 jo s' a before the first inspection. If you intend to obtain financing,consult
with lender or an attorne befor c mmencin work or recording our Notice of Commence ryiepA.
g a ure of Owner/Lessee/Contractor as Agent for Owner ignature of Contractor/License Holder
STATE OFF ORIDA_t5iZQWA� AUNTY OFATE OF O 1DA
COUNTY OF �20GcJ,4-g,��
S orn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
hysical Presence or Online Notarization VZt-' Physical Presence or Online Notarization
this�' day of n CSccy-.►—�6" .20ZD by this day of 20'�by
7)C�ti1s PA AIJ�Z� �w�►zs ��
Name of person making statement. Name of n making statement.
Personally Known Prod tification ersonally Known OR Produce ification
Type of Id ation Type of Identification
Pro Produced
( ure of Not P - r'd Si to to o Florida
Ar V
ommission N ( tNRY RAMIREZ ommission ° LPL �l RAMIREZ
MMISSION#GGl9 MAY COMTvtISSION#GG193970
EXPIRES:March 1 02 EXPIRES:March 16,2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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