HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: s ID ' Permit Number:
RECENM
o n .
•o.. ���:_;. DEC 2 3 2�20
Building Permit Application
Planning and Development Services Permitting Department
t. Luct®0®ianty
Building and Code Regulation Division Commercial xx Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR:
�' I
T*- a�% t '. n 2. _v
PROVEMEN�TLi_ A N a.�,rs„ .S>, �
Address: 3406 DALE PL, UNINCORPORATED SAINT LUCIE COUNTY
Property Tax ID#: �(V p k ®L � Lot No.
Site Plan Name: Block No.
Project Name:
AIR
Rwk�t� I�� � -- 1* ,�' � R �� � ,+ Y,�dh 9�
T
r f
I 4 E
New Electrical Meter Second Electrical Meter
�bra
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:$ Utilities: —Sewer _Septic Building Height:
p Rrl� T
_,� r n t� n� .3. r ' ate �`�NameName:
Address: �fCompany: a
City: Address:Zip Code: City: State:
Phone No. ��L�a, Zip Code: Fax:
E-Mail:Lty► ,h hone No - 1�
Fill in fee simple Title Holder on next page(if different E-Mail �� Gan
from the Owner listed above) State or County License_7f`m�
L
If value of construction is 2500 or more,a RECORDED Notice of Commencement is requir
If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE CO PANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: P ne Zip: hone:
i
FEE SIMPL TI L H� ER: _Not Applicable BONDING P Y: Not Applicable
Name: Name:
Address: t, 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 Countya nd d on the jobsite before the first i spe tion. If you intend to obtain financing, consult
with lend or me b "re commencin work or ing your Notice of Commencement.
Si nature of 0 e/C tractor as Agent for Owner Si na ' e r r/License Holder
STATE OF FLORIDA -S AT F FLORIDA
COUNTY OF BROWARD C U TY OF BROWARD
Swg,rh to(or affirmed)and subscribed before me of Swop to(or affirmed)and subscribed before me of
a/ Physical Presence or Online Notarization %/ Physical Presence or Online Notarization
this�S-l_day of 2020 by this 'day ofhQC•2M/ 020 by
JAYSON ONESCHUK JOHN SETTON
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
Produced Produ
(Sig ture o Nota u ' p, to of
=a�L{E (Signature f Notary P I� t of FldlIpIA AN
MY COMMISSION#GG 361474 MY COMMISSION�t GG 361474
Commission No. :A'• :o EXPI ugust 1,2023 � )Au ust 1,2023
Commission No. g
"'•,FOF f;;°•' Bonded Thru Notary Public Underxriters •,FOR F�R••'� Bonded Thru Notary Public Undervrriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.