HomeMy WebLinkAboutBuilding Permit Application All APPUCABLE INFO MUST BE COMtFOR CATION T ACCEPTED
Date: � Permit Numberg P it 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: W„_ Stu; r —�
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PR� fEPGaR•O�hNj�s�0 �I', 1�
Address: /6(3 2_nre,5< Vr `✓o / 5,/ / ,�N9 s2
PropertyTaxlD#: NIA- 520- nn12 - clan -5 Lot No,
Site Plan Name: n _ Block No. / fv
Project Name: Te Ve,-�e4. Kc,TA ,c
WrfG �cefF LLtpsy�l Fre.rz Lz. !'�o .
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(ey!'11 e '15 (Q _6 '
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 _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 1. " e - Utilities: _Sewer _Septic Building Height:
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Name -rn°nnS GV Name'
Address: 36fr 1� Company: Q,e n Q•ve,r cl"'C'Je ire
City` 1, Sa State:. Address: Kl'S I}2rJl-ors
Zip Code: 3 'U3 Fax: City:-Pl. rip r rc , State:IeL-
Phone No. Zip Code: 14V-1 7 Fax:
E-Mail: Phone Noel S2e//
Fill in fee simple Title Holder on next page(if different E-Mail_/ce-do r:, ecco r.s�.a b 41 1.e,.•
from the Owner listed above) State or County License CAC, i jal.L NG/
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.
I
ESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applica ble
ame: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _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,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 obta' ancing, consult
with lender or an ttorne efore commencing work,or recording ur Noti of Co encement.
A Ly
nature f Ow er/0 e ntr caner S' ati. of n ractor/License Ho
STATE OF FLORIDA [ STATE OF FLORIDA
COUNTY OF Q Q C
���(-�� COUNTY OF iJ 5'� f dL"�
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presencq or Online Notarization Physical Prese a or Online Notarization
this day of 2020 this tUday of 2020 by
S � c�� e�- s g l'
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification J�i
Produced �. �, Produced F—/�4 I
(Signature of Notary Public-State of Florid (Signature Ng;��, ate of.Florida
�' :=stateELLE/y EAU
Com s ' I�' ELLFN V°UGh`N Commissio =
notate of Florida-Notary Public ���FF��"� °mmiS o�da-Notar N
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�:',�iiiP°• am m s1 ibn Expifbs t IOC EXAirei
RE _ ®�®f SUPERVISOR PLANS VEGETATION NGROVE
COUNTER REVIEW REVIEW REVIEW RE VIE EVIEW
DATE
RECEIVED
DATE
COMPLETED
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