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HomeMy WebLinkAboutForkan Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: O r :fir d ° p 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: I PROPOSED IMPROVEMENT LOCATION: Address: I? Jai" pe-w -S i3iyd Property Tax ID#: 4SOX-50 • 142-q , CCO• (o Lot No. Site Plan Name: r Block No. Project Name: r7v_�r �-�txt DETAILED DESCRIPTION OF WORK: -t rs -i5i c :sy5/.m 0M)r)_X) New Electrical Meter Second Electrical Meter I CONSTRUCTION INFORMATION: I 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: 115,3- Sq. Ft. of First Floor: Cost of Construction: $ 12-1 `/y00 ©� Utilities: —Sewer _ Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name—"A7VYla S "I C Y CL n Jp� Name: C?.>� Address: l25+ N(?WeS Ny'd Company: F/ 3' ! S Cit.t3e-a-Glrl State: Zip Code: i C1' S Fax: N Phone No.1"Y2_ vE)S - Csc.P4(I e Addressj :-� j Ni(ti 1 1 l ei' 61 City: P0rfS }- l.i. 0AC,�, State: Zip Code: Fax: Phone No __H2_-�011 .. L02.(P<) E-Mail: LAA- Fill in fee simple Title Holder on next page ( if different from the Owner listed above) E-Mail State or County License LOT, I331ZLp-4' IT value oT Construction Is ZSUU 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 Name:_ Address: City: _ Zip: Phon FEE SIMPLE TITLE HOLDER Name: Address: City: Zi p: Phone:_ _ Not Applicable I MORTGAGE COMPANY: _ Not Applicable Name: Address: State: City: State: Zip: Phone: Not Applicable I BONDING COMPANY: _Not Applicable Name:_ Address: City:_ Zip: NIT07'M 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 lender or an attorney before commencing work or recording your Notice of Commencement. g / / g ature of Si natu a of Owner Lessee Contractor as Agent for Owner I S4A STATE OF FLORIDA COUNTY OF Swo o (or affirmed) and subscribed before me of Physical Pre ce or Online Notarization this`?�day of 2020 by o m 'FpcL,3�Ln Name of person making statement. Personally Known _ Type of Identification (Signature of Notary Commission No. OR Produced Identification State of Florida ) Holder STATE OF FLORIDA � COUNTY OF Sworn (or affirmed) and subscribed before me of P�hyysical Pre nce or -� Online Notarization this ' Ray of 2020 by ',dPYtAYt�i� Coop-e_(" Name of person makiF'®R Personally Known duced Identification Type of Identification Pr uced �rf (Signature of 't=�— — ea ] I Commission No. Notary Pu is Sfa dFlorida ?? Pamela JonesR^ eorA7n 28 P �stft of Flo►ia ExPir GG 9W70 E i 5'6iiii/2024- - --" REVIEWS F R PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED `Nev. 5 6 20