HomeMy WebLinkAboutBuilding Permit Application - Dec 31 2020 - 2-23 PMr—
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /2;O Permit Number:
C1
p Building Permit Application
Planning and Development Services
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:
Address: %r
Property Tax ID #:
Site Plan Name:
Prniart IVama'
A/
Lot No. 0_
Block N o.
ivew ueunLo, IVICLc --- — - -
Additional work to be performed under this permit- check all that apply:
Pond
,'Mechanical _ Gas Tank _ Gas Piping — Shutters Windows/Doors _
_✓Electric /Plumbing _ Sprinklers _ Generator Roof Pitch
S O
Total Sq. Ft of Construction:
/3ry a Sq. Ft. of First Floor; �
Cost of Construction: $
Of Off * Utilities: _ Sewer Sept' Building Height:
Name -�oyo
Address:
����� 3�r
City: State
Zip Code:3 y� Fax: o y
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: 1t'k�)`vk rab[v OIOdG�-
Company: Ne-itonth 6wkyc/ 00
Address: lC! � NS-1 'I L-IN
City: �� ��� k�e ? "'-t S state: Z--
Zip Code: /33016 Fax:
Phone No--
E-Mail oil `.aO��Tic�R,l wl� tyw(D.t<- Cpwt
State or County License _ i1_ i Z6 Z£SO
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.
utarunitlt/tNCUINEER: Not Applicable MORTGAGE COMPANY: .,*"Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 our Notice of Commencement.
1&�r IAIJi�� /X-ow� f. �J46_0_
Signature of Owner/ Lessee/Contractor as Agent wrier Signature of Contractor/License Holder
STATE OF FLORIDA LU �t STATE OF FLORIDA
COUNTY OF e- COUNTY OF L
Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
4 Physical Presence or Online Notarization � Physical Presknce or Online Notarization
this day of 01Q 2020 by this L( day of IJP c a,, o� 2020 by
L7(l 0•.4, ? IJo biota. .
Name of person making statement. Name of person making statement.
Personally Known _ ( OR Produced Identification Personally Known X_ OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Nota
ROJARA (Signature of Notary Publ'
Notary Public, State of Florida .►*• LIZA NOELIA 0WAMR0 'ARA
Commission No. +►.n.� mission j�08446023 Commission No. 5tateWFir.�a
a. Commission Expires 09123/2024 N0. HH 4F
a ti Commission Expires 0912's' -,'_;A
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW DATE REVIEW REVIEW
RECEIVED
DATE
COMPLETED
ev.