HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
i Permit Number:
S51ro [LUCDC�
RECEIVED
Building Permit Application oEc 1.01010
Planning and Development Services DePa�Mont.
Building and Code Regulation Division Commercial �- Residential �erml , county
St.
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
,
Address: '3j00 iwi✓ Aig J sAAMP r 3yy(l9
Property Tax ID #: i LiZs (o04 - 0031 - 000 Lot No.
Site Plan Name:
Project Name: _SAAd)X ON 7W OC941V
Block No.
N EEslo-1aM -fd j�Q~ry_zs/►?iyTs ScKs • 2 3� W �, 7 8 9, i a
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
Total Sq. Ft of Construction:
Cost of Construction: $ 4700 i)001 Oe
Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Utilities: —Sewer —Septic Building Height:
��g01IIVER�LESSEEIt
_SeL.eY�S. fw. _ ,s4'..w.:`S .tiiw:lU 3..tk`Je.L "I. ri'.,`b
rF�00VAM.
�','�«.Ft Sil. a.'.-1�., .Y+�,'�ff. .k� �^.a.k a... _ ei Nn ..✓J_
Name cowl
Name: Ar. ST�9�2dC
Address:.3106 Olt
Company: "7r cicrV44, 40^2
City: 6CA 14 SIAMPState:
Zip Code: _ Fax:
Phone No. 2
Address: /AD, ,84�
City: State:./ 11
Zip Code: Tyd Z Fax:
Phone No 2u- /63/
E-Mail
WCUMPANAq cowpa. Nff
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail SuQyY�ts/2Ga✓�I r �''!
State or County License
If value of construction is Z5UU or more, a KtLUKUtU Notice or Lommencement. 1s requueu.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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VSUPPLEME
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TAL CONSTRUCTION LIEN
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LAW�INFOI�MATION
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DESIGNER/ENGINEER: _
Name: 5YAAW AI uNGIAW!MA(G
Not Applicable
MORTGAGE COMPANY:
Name:
— Not Applicable
Address: 7S Negr&496 040 56TC
Ze
Address:
City: APAY &04 SM4#
Zip: 3390g_ Phone
State: fl.,
0
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY:
Name:
Not Applicable
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
structure. Pleasle consult with applicable
ome Owners Association and review your deed for any restrithat
t ons which ma apply.
prohibit hlbit such
Y
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
.�L �_._�__ __ __ ,, .., L.. 4 .,,,nm nrinrr %Ainrlt nr rornrHina vniir Notice of Commencement.
WILII ICIMU1 UI C3JJ CILLUIAICY LJUJUlcwiii��
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 4/9c t
COUNTY OF
Swor o (or affirmed) and subscribed before me of
Sworn�(or affirmed) and subscribed before me of
Online Notarization
Physical Presence or Online Notarization
day /1/e1119tP 2020 by
✓Physical Presence or
this day of d✓Df/ei7Q_, 2020 by
this of
_i�_
/�lrL �4e r,Ay1l14, A; . �
�d
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known � OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced t
I nature of Notary Public
g ry
ignature of Notary bar+ telat�ta6�hoPid6is0tF
�`F; Shannon 0 onneU
��M ! Notary Public State of Florlde
Commission No. ��11
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mmission No. Hxpires081 � 2
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� Expires 08/13/2022
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COMPLETED
Rev. 5/b/ZU