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HomeMy WebLinkAboutBuilding Permit Application i I All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED J 0 Date: / _� _z a Permit Number` q S ©o Building. Permit Application Planning and Development Services I I Building'and Code Regulation Division COCT1171e1'C18I Residential 2300 Virginia Avenue,'Fort Pierce FL 34982 { Phone:(772)462=15'53 Fax:(772)462-1578 PERMIT APPLICATION FOR � �.Umm2�-c.ta� ���, �L q� 1q©s 6Qy► 1 1 ti Address: •7/ 3 7 S U.S._,.2 � � Property Tax ID# ,. Lot No. � 4 Site Plan Name: Block No Project Name: rI d u5 e .,r,'A,� ;:a '" r ' `;E t..� .� f�,.a,4 °�'*�. ''�i7rS���•�y r't-fi�'` -;i'''rrf`'c s 3 R�xp�„�}�+ - Y�� t`aa'kt's-7't''�„3'f�4vyi w�,y'3y-.Y` 7 'fl`F,: Q��TAILEQ D�SCRIP�TIO�.OFA1✓�V�OI�K..t �u� �L� H �� ������-�� � ``=.�.� x�.�r� � �„��� �����r � �. u � ��,: I New Electrical Meter Second Electrical Meter "' S 3 y�" "`t q,S +a r. ���^:` I:; , '� 1`y�'..`"@.3.. nDJ�'S.•.C .�Y Yf 4}... d �xy f,A-J�.;:i �� �.�� Y3fi���` � I{ I{I ,."Y,F .!vz:7•.,`f.' F Y r£�i`v, ',A.�.: � .,.v'hw i:'-a,^:.:T �'`:•q�:s ��..a.J Additional work to be performed under.thts permit-check.all that apply , I, _Mechanical' _Gas Tank Gas Piping _Shutters ;Windows/Doors _'Pond Electric K Plumbing - -_Sprinklers, _Generator_., _Roof:;._ Pitch_ Total Sq.Ft of Construction: Sq. Ft.,of First Floor: i Cost of Construction:$ Utilities: _Sewer _Sepik' f =Building Height:. QYY`N�fAt xs +�U,iptc'`� �G r,r`a �, .m-... 4 Name 6v✓:/ ar/tf Namet y �t I Address- I < E w.va�t�NPy �tre%- }Company : .11,i i tkkk4d ;,i P f- `° Zip Code: 32-9"27_. Fax:. _ City ' State: Phone Np: 0.3 _ ff 4'fI -I fL3 ] Zip;Code; �' Fax Phone No Fill in fee simple Title Holder on next page(if different E-MailYI( Gt�IIXD. from the Owner listed above) 'State or County-License 5 LZ If value of construction is2500 or more,a.RECORDED Notice of Commencement is required:` If value of HAVC is$7;500 or moie,,a RECORDED Notice of Commencement is required. " PPLEMENTP►L CONSTRUCTION L'I�N.IAW INFORMATION _ ° ^' T�b�r-� �. r c s x n '. Sfi.a 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. Inconsideration 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 poste on the jobsite before the first inspection. If you intend to obtain financing, consult with lender or an attVrAy before commencing work or recording our Notice of Commencement. a re of 0 er/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder-. f STATE OF FLORIDA STATE OF FLORIDA COUNTY OF .�9J�t.G COUNTY OF 010,V, Swonrn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of, V PVsical Presence or Online Notarization Physical Presence or Online Notarization L this—`day of 2020 by this 181�day of N6v, 2020 by Icny � endore, R 'lc�,, ��• Name of person making statement. Name of person making state ent. Personally Known OR Produced Identification�_ Personally Known X OR Produced Identification iType of Identification \ Type of Identification Produced {-1. d r►y4YS Lu P ys1 Produced Lk (Signature of Notary Publi a State of Florida) (Sig ure of Notary Public-Stat% °da)Commission#GG 188940 ,�pgY PUe LISA A,RILEY o •..�% i c ma 4 . Exes February 22,2022 Commission No. -� �� w Sealpmmmslon#GG15743 Commission No. �$�0 'D ''Fotitoa (S kltniuyemotw op Expires l4oveatb3r 2%2 9 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW i DATE RECEIVED DATE COMPLETED tRev. i