HomeMy WebLinkAboutpermit 2012-0660,III ANTI ICAIII I INI l) f1111SI III. COMPLETED FOR APPUCATION TO BE 4CLUPU0
t).'JV, 12127/2010
Perm l Nurretp^r: J 013 ~ �, ,
V ' Building Permit Application
Y
Plonn1119 and Development Services
Ouildingand Code Regulation Divlsion Commercial Residential X
2300 Virginia Avenue, Vat Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: \-�� SC a Vk �� � C� [�L F- L 7,L1G
Property Tax ID it: - t - tot No.__-_r?
Site Plan Name: Y Block No. r
Project Name:
DETAILED DESCRIPTION OF WORK:
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J�Cit` ,�r�i1•�.1�''r,..1 1<�!• r�._�rl ri.�r� iYiJ��•ti�,�I
V y
New Electrical Meter Second Electrical Meter.
CONSTRUCTION INFORMATION:
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: $ c l . Utilities: A Sewer _Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name FU ,
Address: 13q slpykir
Name: e
U 7f
Company: HeiY4'l. 1 / f �
Address: v l' &' Ct v Sf-
City: L State:
Zip Code: Fax: ll
Phone No
E-Mail Pl
State or County Li ense E
City: aS 1. State: �EL
Zip Code: 3 g Fax:
Phone No. � b�
E-Mail: C"DWI
Fill in fee simple Title Holder on next page ( if different
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.
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SUPPLIEMENTAL CONSTRUCTIM LIEN I_AW iNfORMATION:
FDL'sIGNEit/ENGIN[Lli:
Name:
Address:
City:
Zip: I'hnne__
FEE SIMPLE TITLE ITOLDLR:
Name:
Address:
Citv:
idol Ai plicabl(-
stdIe
Not Applicable
MORTGAGE CONUANY
Name:
Address:
City:
Zip: Phone;
BONDING COMPANY:
Name:_
Address:
City:_
State
Not Applicable
Zip Phone: I Zip: Phone:
OWNER/ CONTRACTOR AFFiaVIT: Application is hereby made to obtain a permit to do the work and installation as Indicated
1 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 Horne Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Horne 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 attornev before commencing work or recording our Notice of Commencement.
FVAAgnatuwner/
Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FL DA
STATE OF FLOR.
COUNTY OF-•LG-G
COUNTY OF _
Sworn to for affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
sisal Pr ence or Online Notarization
�+�ical Pr nce or Online Notarization
this day ��M 2020 by
this ay of 202Q by
of
gaffl&t' AO&
wmf46n Ae& Wo
Name of person making statement.
Name of person making statement.
Personally Known OR
I
nally Known OR Produced Identification
Type of Identification ��, Notary Public State of Ron Ty _ of Identification
ro ced Lisselte I Diaz Pr aced 101
My Comrmssion HH 01930 No 7 PubLc State o' Flonde
a Lissetie I. Diaz
4or Exp res 07�08'202a
A O��
AAU� '• p hty Co —Ninon HH 01S3a3
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oiFL Expires 071o&2
I5i na tit rQ# t � Pu i' State of Florida)
i g�`��r� St
Commission No. ;�r✓-1 {Seal)
Commission No. T� (Seal)
REVIEWS FRONT ZONING SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER REVIEW REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20
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