HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED. 'j y
Date: _ , I �� •� Permit Number: oG
RECENED
NOV 1.9 :1020
Building Permit Application` ftyltittingDepartment
Planning and Development Services St. Lucle County
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:
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,PR,ka POSED�IMPR,OUjEIUIE^N;0'" {'
,rt . ,. {. _r'.ry 3aee-,-�,.: <l..._ s.xi�€ �^.. s• _..c.a�. ,
Address: _T_-Z o 2 d' U_:'l Be-vid Law e-
Property Tax ID #: O 0 — o OO :P Lot No.%?
Site Plan Name: Block No.
Project Name:
-17e irk re m ro&d .
New Electrical Meter Second Electrical Meter
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: $"�`� Z0 Utilities: — Sewer _ Septic Building Height:
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CONTRACTOR
Name JO-14P5 R ��/1W�5�Ica-,�f�r�
Name:.
Address: T 2a2 (ccdr C„ jje'�(el ,L �i
Company:
City: &'�. P, C %AC a State: Z.
Zip Code: 3 IV95- / Fax:
Phone No. 0-06 W lLll /z,% /
Address:
City: State:
Zip Code: Fax:
Phone No,
E-Mail
E-Mail:_ � re -( 16 b a , '9 C gjmat C"ty
kV NJ
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License
ii value or consirucuon is zSuu or more, a KtCUKL)W Notice otCommencement is required.
If value of HAVC is $1,500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _ Not Appli-able MORTGAGE COMPANY: _ Not Applicable
Name:_7rh m e, 1!0_WP)PeA_ Name:
Addresses 9 v�aR. Address:
City: a I Stated _ City: State:
y Phone Uo 7� - 5 S"�,� _ Zip: Phone:
Zip:
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 on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording your Notice of Commencement.
fg5,,-a;t_u�reofer/ Lessee Contractor as Agent for Owner
STATE OF FLORI
COUNTY OF
Sw�to (or affirmed) and subscribed before me of
P sical Presence or Online Notarization
this J day of Chi rV • 2020 by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced`
n rb,, lod —
(Signature of Notary Publ
Commission No.
REVIEWS I FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
AUDREY B. HUMrni
,My COMMISSION # GG
EXPIRES: March 6, :
Bonded T hru Notary Public U
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of 2020 by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
SUPERVISOR I PLANS
REVIEW REVIEW
re of Notary Public- State of Florida )
n No. (Seal)
VEGETATION I SEATURTLE I MANGROVE
REVIEW REVIEW REVIEW