HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: lam rl`202D Permit Number:
4
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Building Permit Applicatioftr,,hz ANO
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:
PROPOSED IMPROVEMENT LOCATION: C,
Address: (0 0. G l a 41�S f 0 24 lop
Property Tax ID #: N 5,- YI/ /-00ol —0 00 % Lot No.
Site Plan Name: S L C /an d
AV Block No.
Project Name: �L C ton d A'/l
DETAILED DESCRIPTION OF WORK:
H
a h-', /2 u-Ps PAY y ,/�' )(0 (a
'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
_ Electric Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ i Fool
_ Generator
_ Windows/Doors _ Pond
Roof Pitch
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name C Q V
Name: �[1 r'S k
Address: (9(6Q
Company: SC/`&-t!'1S�
City: jF',l 'lE? State:
Address: 33/7 s w; )%,ry
Zip Code: N $ l Fax:
City: pi 7i Lr Stater/
Phone No.
Zip Code: Fax:
E-Mail:
Phone No 77a - Fol 1-42 0�
Fill in fee simple Title Holder on next page ( if different
E-Mail �'� `r 2 7&as:•i ?, Y 'M a
from the Owner listed above)
State or County License D 73 0
it value or construction is Z500 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.
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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:
u
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 obtain financing, consult
with lender or an attornev before enmmencinL7 work nr rpenrriino vnur Nntirp of rnmmpnrpmant
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 5T
COUNTY OF ACT
Sworn to (or affirmed) and subscribed before me of
Swor o (or affirmed) and subscribed before me of
Physical Pre nce or Online Notarization
'"'flay of 2020 by Dpyvtts
�.Pyslcal Pre ce or Online Notarization
this day of �Q-(�ryl�--2020 by
I C
Name of person making statement.
Name of person making statdndent.
Personally Known OR Produced Identification t--
a /
Personally Known OR Produced I Ic ion v ='
Type of Identification
Type of Identificatl0 /
L,
Produced Y\tLA -r� c�,2s
Produced
DOREEN
(Signature of Notary, to p8
!GG
E56
(Signature of Notary St POLINA SOROKA
Expir
.dNc�ary.Public -State of FloridComm.
Public-
Commission No.
°�` Co fission rr GG 263732
Commission N ` ,�F` LC�
� eaq�.e�'. Expires Oct 1, 2022
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
;t, q? 0
i
-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.
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 attornev before commencing work or recording vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF CT f
Sworn to (or affirmed) and subscribed before me of Swor o (or affirmed) and subscribed before me of
Physical Presence or Online Notarization P sical Pre ce or Online Notarization
this day of 2020 by this � day of �020 by
Name of person making statement. Name of person making stat ent. A
Personally Known OR Produced Identification Personally Known OR Produced I i is ion v
Type of Identification Type of Identificatio I
Produced Produced L_
of Notary Public- State of Florida POLINA SOROKA
(Signature ry ) (Signature of Notary Public- St d�o�ary Public - State of Florid
t Co fission N GG 263732
Commission No. (Seal) Commission N Expires Oct t, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW 'REVIEW REVIEW
DATE
DATE
COMPLETED