HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFOr MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: IZ�I ZOZi) Permit Number:
01ro
O f
".4 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:
y,P,. Ry rPAS--LaE+,®.;.;?SIM....d_P++ RA®.. lUE.+'x w..N;,�Ks�fla+.3.";�}+=L.:rOa°.rcq`rt'C..c..t..A.� ,Tx. ��;IO>,s. :t3�t�=_'.,a;` ,fj• y.,_K..��ru E.x�. r�` _�n_oC`-em. s.«+ '?�"N3�-aR�_As9Mt= :•L,
Address: S[v% ziaua,-, &^oi 1,,A^9 .
Property Tax ID #: 131 A ' O Cop ' 002 1 • 0000 Lot No. 19D
Site Plan Name:
Project Name: TG-u I<e 5kerJ
New Iu `x If,, 5fVr•'1§:? Sked.
New Electrical Meter Second Electrical Meter
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CO�VSTR+UVTI®Nz;IN�F�ORMAT,1®tN
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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:
Cost of Construction: $ 0� Utilities
Nam
I.
Address: 5'1 v i Z,yAi z� ggenri L_tJ
City: F co--�- Fi er to State: FL.
Zip Code: 3`IC15 Fax:
Phone No. '-iZ5 — °I31
E-Mail: 6 b h. 9R 3a, o CoM
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Sq. Ft. of First Floor.
Block No.
Windows/Doors- _ Pond
Roof Pitch
— Sewer _ Septic Building Height:
Name:�X1-� F• �'i� ��tiP'�'r'
Company: _CXL
Address: T1o7 Tim.(1"w. fra"a Lr')
City: 6, — f t CS'cp— State: FL -
Zip Code: 34g5 Fax:
Phone No 425- c01- Z$4 `f
E-Mail
State or County License N �A
If value of construction is 2500 or more, a RECV RDtu Notice oT LommencLrnum _] 1 t:4U11 Cu.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
�S 9;PP-LEM'EN= ` `L�NS�R+UC��IOI��LI y � SUV t�OR;
'1TI®
� '
MORTGAGE COMPANY:
_ Not Applicable
DESIGNER/ENGINEER: _ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City: State:
Zip: Phone
Zip: Phone:
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 instanation as inaicaLeu.
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. Please consult with your Home Owners Assoc ation andrreview your deed or any restrictions which m y alprohibit such
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 In ff rinsspection ng of yN rice of Commencementu intnd to- obtain .
consult
_.. .-1_ 1_ _J_.ma,.........,
WILII ICIIUCI UI tlrl LU1 rlc V cr ulc �W§I—
Suture of Owner/ Lessee/ ontractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 2hrk" �
COUNTY OF
Sworn to (or affirmed) an subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Presence or Online Notarization
this , day of p %A 2020 by
this day of 2020 by
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
(Sig ati.re of Notary P - E, o ida)
(Signature of Notary Public- State of Florida )
'-.
_.• 9yLAS 0: HAH AI GRAM-RAHMING
Commission No. ;il #: - _ MY CO;
''t��OF
Commission No. (Seal)
EXPIRES: December 20, 20220
FlOaO - , 2O2
u lic Underwriters
REVIEWS
FRONT
ZONING
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20