HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
D.-i t e Permit Number . -
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P `� � Building Permit Application
Planning and Development Services
Bu►ldrng and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fart Pierce Ft 34982
Phone : ( 772 ) 462- 1553 Fax : ( 772 ) 462 - 1578
PFRMIT APPLICATION FOR : e A ( e. �t! Qt JJ 5do oun YbOfy
PROPOSED IMPROVEMENT LOCATION , ir
Address : � S �- - —.� _ �l 'fit I p ../ Q
Property Tax 0 # : � �G � ( — l � - (� S �- � CiC� — o� Lot No .
Site Plan Name : LOUAIVf�eCC� 12Q. c4.; r . _ Block No .
Project Name - 4dp ..
DETAILED DESCRIPTION OF WORK :
_(I' ve L A 1%0 Ai�
iA
e )19 0,j�Ck C C a v► n � l t c�
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION : 01'. *- *
Additional work to be performed under this permit — check all that apply :
, Mechanical � GasTank � Gas Piping _ Shutters _ Windows/ Doors _ Pond
Electric _ Plumbing � Sprinklers � Generator Roof ditch
Total Sq . Ft of Construction : � _ Sq. Ft. of First Floor
Cost of Construction : $ . � �r � c� Utilities : _ Sewer _ Septic Building Height:
� OWNER/ J" E : CON -FRACTOR :
Name � . Gina r � �..• G U �.,► _ Name :
Address :� � � �., .5l� lift&k % 41 0%k r D $ , Company: - - --
r
city: ^ V � s �� � t�. 0 tvs state : Ft- address :
Zip Code -. _ 3 4 °l � -7 _ Fax: City : Sta te:
Phone No . "7 T,)- �-! � s � +7�� - - dip Code '. ._ fax :
E -Mail - 0 A S' ,f °C.. �,.e, � , � 0 Ae\ Phone No
Fill in fee simple Title Holder on next page ( if different E - Mail
from the Owner listed above) State or County License
1f 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 .
SUPPLEMEN rAL CONSTRUCTION LIEN LAW INFORMATION ,
DESIGNER/ EN-GINLER .-
Not Applicable MORTGAGE COMPANYo. Not Applicable
Name :
--� - - - Name : mpm
Address ; _ _ Address ,
City: State : pity : State .
Zip . Phone Zip : Phone :
FEE SIMPLE TITLE HOLDER-0 Not Applicable BONDING COMPANY . Not Applicable
Name . Name '.
Address : Address:
City: City :
Zi p : Phone : zip ; Phone :
OWNER/ CONTRACTOR AFFI QVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
certify that no work or installation has commented prior to the issuance of a permit .
St . Lucie County makes no representation that � 5 granting a permit will authorise the permit holier to build the subject structure
which is in confect with any a pplicable Hame owners ssociation rules, bylaws or and Covenants that may restrict or prohibit such
structure _ Please consult with your Home Owners association and revEew 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 (ollowing building permit applications are exempt from undergoing a full cancurrency review ; room additions,
accessory structures, swimming pools, fences, wdt15, 51g115, screen rOOf1"15 and accessory u5e ; to another non-residential use
WARNING TO OWNER : Your failure to Record a Notice of Commencement may result i n 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 attorney before commencing work or recordinR your Notice of Commencement .
Signature of Owner/ Lessee/Contrau6r as Agent for Owner Signature of Contract or/Licen Se Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF , -�, � COUNTY of
Sworn to ( or affirmed ) and subscribed before me of Sworn to (or affirmed ) and subscribed before me of
V/ Physical Presence or Online Notarisation Physical Presence or Online Notarization
this day of L0._C 1PVY1VaJQ, 1 , 2020 by this day of , 2020 by
L\LC1 V-C LQ S Y--\
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 S 2C(C-) C) Produced
( Signature of Notary Public- iep F,,-v i &SSANORAMVouG� ( signature of Notary Public- State of Florida }
Notary Public -a State of Florida
Commission No. Ce-1 ( �(�I�Issian � GG C G� �. r
� 923210 Commission No. Seal )
My Comm , Expires Oct 16 , 2423
Bonded through Natsana! Kotary Assr►•
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVI EW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev- 5/6