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HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMA � ED FOR APPLICATION TO BE ACCEPTEC�, //�� ^ Q Date: Permit Number: C::D pC '� 1 0 0 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: PROPOSED°IMPROVEMENT LOCATION Address: /1590 cS6_ 1 V1,-T2. kn Property Tax ID #: _o143 a r- 33a - ©ob a " 0 00 -- -7 Lot No. Site Plan Name: Block No. Project Name: DETAILED DESCRIPTION OF WORK: _ - T�►s7oII yao l�o I FA Al Amp P;P N�a80 ,3� v �`ro�e Tipa-F WAC_ I�X:OiNe, 1/e�rf�`IA �o� hJo�P i,P GAS New Electrical Meter Second Electrical Meter CONSTRUCTION INFORMATION Additional work to be performed under this permit- check all that apply: _Mechanical ✓Gas Tank _vGas Piping _ Shutters _ Windows/Doors _ Pond Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ i qo0 •O% Utilities: —Sewer —Septic Building Height: OWNERAESSEE , ., , ,- `.CONTRACTOR:.;, Name �2Ug Abuse°YGr_ 4Me�j ASrSoc�� � Name: Tp �eS Gib L� Company: ;5109 11A GAS �Pd�ss Address: Z& O S- 10fLw-A- u' Address: 4/D1sq so ill,'i (zD City: P)'eAtk T State: Zip Code: Fax: City:-9+VP4t Stater Phone No. g4t_71F- o1ggq Zip Code: Nq i, Fax: E-Mail: Toe `Xo!1Ano.Se.7em+#ua (' . o�W Phone No `772..- Fill in fee simple Title Holder on next page (if different E-Mail �M �(;/yy20i� .Co•� State or County License of 10515 from the Owner listed above) 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. R 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 An the jobsite before the first inspection. If you intend to obtain financing, consult with lender or an attornAV before -commencing work or recordine vour Notice of Commencement. dit AA# n IL"It"If OA �. Signature f Owner/ Lessee Contractor as Agent for Owner Signature f Contractor/License Holder STATE F FLORIDA STATE F FLORIDA COON OFstLude COVN OFSCLude Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of x Physical Presence or Online Notarization Physical Presence or Online Notarization this 19 day of January , 2020 by this 19 day of January , 2020 by James Gelsler James Gelsler Name of person making statement. Name of person making statement. Personally Known x OR Produced Identification Personally Known x OR Produced Identification Type of Identification Type of Identification Produced �j� 0a Produced &4"�MOA (Signs a of Notary P 1•G�;S„ t tg o on GAL (Signs a of Notary Publi a. Florida ) EMILYGALEN o MY COMMISSION#GG165462 ?• '°;e �� `? p -= MY COMMISSION # GG 165462 :.; ;.: Commission No. 165462 '";• EXPII49g16cember5,2Q1 CommissioNo. lssasz =A F )December5,2021 Pon Bonded Thru Notary Public Underwriters Rff`:°''Bonded Thru Notary Public Underwriters REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Kev. 5/6/zu