HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST OMPLETED FOR APPLICATION TO BE ACC :D
Date:I Z/-L 3/2. ,L Permit Number: Oc 0lcz- C�S4 1
OE
° Building Permit Application
Planning and Development Services Pener 20'10
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34982 We Can n�nt
Phone:(772)462-1553 Fax: (772)462-1578 A
PERMIT APPLICATION FOR:
Address: 771E Priw.,k ViJ, 61v2 Port Si. L ;e, FL349S1—
Property Tax IDA: 3414-51.5 - 015S-00o-7 Lot No. i
Site Plan Name: Block No. 'L5—
Project Name:
® ED D SCRa ®,
mt: s _�., f,� n �..0 .
fix_ }� iiww F' I{ fcs_1 -k J v t1, vc ,kt Aj h �O
�wnrls }LC �tK of }►.,t �a�.5t.
New Electrical Meter Second Electrical Meter
C�0 O' 0 ra �i st
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:$2 L oo•r Utilities: —Sewer _Septic Building Height:
Name (-Fr1 Sowc Itg Name:
Address: S 94t Nu el16rl Avc— Company:
City: Q-r t St 1 wlc State: FL Address:
Zip Code:34983 Fax: City: State:_
Phone No. 954-6oS-M9 S Zip Code: Fax:
E-Mail: 6�4c�►L3,Q-y.i,ao.co— Phone No
Fill in fee simple Title Holder on next page( if different E-Mail
from the Owner listed above) State or County License
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.
DESIGNER/ENGINEER: _ Not Applicable rvMORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _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 Counttyy 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 attorneybefore commencingwork or recordin our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA, , STATE OF FLORIDA
COUNTY OF 1` s COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presepce or Online Notarization Physical Presence or_Online Notarization
th i§J_J day of Lk 2020 by this_day of .2020 by
ZINZ0 nA
Name of person making statemko Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Id tificat on Type of Identification
Produ >— Produced
(Signa ure of Nota 4 6MWOMitl6QA+,1-RAHMING (Signature of Notary Public-State of Florida)
MY COMMISSION#GG 27M=
Commission No. ':%F••.." + EXPIRES:qef 20,2022 Commission No. (Seal)
Olfded Thin Notary public Undenvriiers
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.