HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ��r'',, QQ
Date: Ia I5'Z27 Permit Number: QU 12. 0 3U5
RECEIVED
�40 wcm DEC 1 51010
Building Permit Application Permitting Department
St.Lucie CountY
Planning and Development Services
Building and Code Regulation Division Commercial _ Residential
2300 Virginia Avenue,Fort Pierce FL 34981
Phone:(772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR: Qt t ' gtwf�
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P� ,! ;iSED`I'-fV1PROVEIVIENTL'OCATION' s�4 (� ', .� :+ � � �udh"
Address: /„oC_�p2irt '�i yD ri ��rYLGC Fr 449� I
PropertyTax ID a: Ifni t' f 1 672D DF» I Lot No.
Site Plan Name: Qr;arrwr: Block No. tin
Project Name:
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S V Gte tytn e (M.t T-iLt- 72m y,�E
New Electrical Meter Second Electrical Meter
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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 K Roof 41IZ Pitch
Total Sq. Ft of Construction: '76o Sq. Ft. of First Floor:
Cost of Construction:$ 3si» °O Utilities: Sewer _Septic Building Height: 1
i
Name 6i�iAzi, Name: 4-i
Address: /.St>S Aloa-%1f gt yP Company: A b , .. e2e: _. c6 IiL
City: 1=f Pte0-4,6 Stater Address: -;zzt pLeA lye,rz_ AtoF-
ZlpCode: ,LA�15- Fax: City: Fc Ptt sum State:_EL,
Phone No. 77Z '742 SOSD Zip Code: '7.4 k9 2. Fax:
E-Mail: Phone No Z7 z - 2 Lfo - fc LV-7
Fill in fee simple Title Holder on next page(If different E-Mail-'4cv,yA,4 �✓ &"*+.t Gsr_ . s
from the Owner listed above) State or County License CCGOSSc T3 / tazKq
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.
FrAdd
rrtt ,..NGINot Applicable
�tDfo Address:• ecState:
o Phone �{�p Z tS'1 Z(p: 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 Counttyy 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.' public records of St.
Lucie County aDJ17psted Dp the jobsite before the first inspection. If you ialeilb to obtain financing, consult
with lender oran,005Fneybefore commencing work or recording o tice of Corrimencement.
Si ature of Owner/Lessee c or as Agent for Owner Signature o Contractor/License Holcler
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF`�, . LI ric COUNTY OF
Swor to(or affirmed)and subscribed before me of Sworwto(or affirmed) and subscribed before me of
slcal Pres c or_Online Notarization ✓Physical Pre nce or Online Notarization
this day of 2020 by this day of 2020 by
Name of person making stta ement. I Name of person makin/g statement.
Personally Known ✓ OR Produced Identification Personally Known " OR Produced Identification
Type of Identification Type of Identification
Produced Produced zA
(Signat (Sig to Public-State of Florida J
:* KAREN S. NIELSEN
yp KAREN S. NIELSEN al
h-State of FIOriGa-Noter pyyggl�'�c �o
Commis d = eiee*N GG 2dYd8X Co �.,i"�'�"9 _ )
=y - - otary Public
'•.?.,,i; � My Commission Expires x a Commission #GG 207484
June 7 xPiro$
REVIEWS FRONT ZONING SUPERVISOR P MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIE REVIEW
DATE
RECEIVED
DATE
COMPLETED
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