HomeMy WebLinkAboutBuilding Permit Applicationf=
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All APPLICABLE INFO MUST BECOMPLETED FOR APPLICATION TO BE ACCEPTED d 12
Date: i1�•�• Permit Number:
RECEWED—
S LUM��
Planning and Development Services
DEC 09 1010
Permittin9'D6partment,
St, Lucle County
Building Permit Appl-ication
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: A113Mi 001A SCRUV-)
Residential
1EOC.LC-)SURA .
Address I 1 9 _-) - I I P'1; ;. '.k C.l GZ t�'PsLI� CC`�
PropertyTax lD #: y�1ZCo �0'L'0�15 -��Lot No.
Site Plan Name: 70S LT'IA 5 H M- Block No.
Project Name: SC CI-'TC-1_CS
SCSLU IJ
New Electrical Meter Second Electrical Meter
Additional work to be performed .under this permit- check all that apply:
Mechanical —Gas-Tank Gas Piping _ Shutters
_Electric _Plumbing _Sprinklers _Generator
Total Sq. Ft of Construction: Q$y '
Cost of Construction:
Windows/Doors — Pori'd
- Roof, Fitch- -
Sq, Ft. of First Floor: —
Utilities: —Sewer _.Septic
Name:_
Building Height:
ame
Address: 1U�i7t-1Q)0G?N C t' I Company: T(t�S 5CCLLUJ W� kWyXI&`
City: IPP0-n C IT -f State: PL
Zip Code: -34 920, Fax:
Phone N
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Address: Z%R 'b CsLPO-3D ID7",
City: P� S . L State:-r—L
Zip Code: 3L1915—L Fax:
Phone No
E-Mail 1=1f.SOSSC2,� �t i • ��t
State or County License
If value of construction is 2510 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
J
DESIGNER/ENGINEER: Not
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit.to do the work and installation as indicated.
I certify that no work or, installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants, that may restrict or prohibit such
structure. Please consult With your Home Owners Association and review your deed for any resteictions'which may apply!
Inconsideration of the granting of this requested permit, I do hereby agree that I-will,-ih all'respect-s, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full coricurrency`reView: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory' uses to another -non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property: A Notice of Commencement must be recorded inAhe public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with len r -or-an attorneybefore' commencin work or- recordin g -ou.r Notice of -Commencement,.. ,
ev.
MORTGAGE COMPANY:
_Not Applicable
Applicable
Name: `Pf�lSl. 1..S�,LG1�
1 IJC
Name:
Address: ]984 I31 Li Ntact.E.
ST,
Address:
City:
State:
City: F. S. Stater_
Zip: 3-Zq,R� Phone °��
— i8� =9 `�3$�.
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone;
Zip: Phone:
Sig t r caner/ Lessee/Contractor as Agent for Owner
Sig of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
Sw�to (or affirmed) and subscribed before me of
Swoyr�to (or affirmed) and subscribed before me of
Physical Pre ence or Online Notarization
P ysical Presence or Online Notarization
this � day of � 2020 by
��
this � day of 2020 by
YZI7
Name of person making statement.
Name of person making statement.
Personally Kno OR Produced Identification -
Personally Known' 'OR Produced Identification �
'
Type of Identifica
_`��
Type of Iden is ii
Produced � �
Produced
(Signature of Notary Pu c- State of Florida)
a
(Signature of
AUDREY B. HUMPHREY
Commission No. ;•k�se�a1-•, AUDREYBtgp HREY
Commission
,•<P1Ye��;.;
MY COMMISSION#817
March 6,2023 �.j
MYCOMMISSION300817,_EXPIRES:
EXPIRES: Marcho2023 ;;,.,eo�Fv�,.��a'Publicunden<rtiteon
WUN
edThru Notary PREVIEWS'SUP,�RVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
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RECEIVED
DATE
COMPLETED