HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUSTTBE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: f '2 p2Q2-� Permit Number:
RECEIVED
JAPE, .9 2021
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Building Permit Application Permitting Department
Planning and Development Services
' Sk, Lucle County
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: „ `�
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PROFOSyEbfIMP OVEMENTLOCAT�O �3 K x,,� <, �;s �a�k s a W11tN...re-,, <L._ya.ra,.a..._ .n, �,._,u�a..=. ,s*.:u•:.,s.. ..r.� ras., r.....,.»,':c..a,»S a ,....,t+�. ,gk irl.s�.'cc'L..�1+• 3.i._;tta :�-r�e�t5.,�;.�;�:_..a,. t��+_.�F.�.._rts
Address: G �SIYL� 9�
Property Tax.ID#:_ f 1i`0n-S�—; 1--0 04 7 -3 i 0 f Lot No. _
Site Plan Name:REY-i (AANVh Block No.
Project Name: �/�j/r;� I*A-V�
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New Electrical Meter Second Electrical Meter
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Additional work to be performed under this permit=:check all that apply:
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_Mechanical _Gas Tank'"" _Gas Piping _Shutters _Windows/Doors —Pond
_Electric _Pfu•robing'' —.Sprinklers _Generator .,Roof'•' , .,Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: —Sewer _Septic Building Height:
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OWNER LSSEE - `
1 h„ / x, r4� CO'NTRfA�TOR, �, F
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Name Name: �YlAr�ikCi -
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; Address: " ` ` «
�� 7 �,a,�_� � papv czv� 1�1.arsl��►(1 Csen ec�n4- Sarr
h r City. „" 7' ! Sta L `Address:a 080 ,"T1'1yc'R(.c)(k ' }t�V f
5[ nZip Code r 'Fax: u r,)* r�,City g\m, Bb V . . State: FL
r�•: �Ng t IC7 7 7 Code''T; 'M 90 Fax:
E-Mail: . tf•r- 7t`Rhone4o°uCl'4
Fill in fee simple Title Holder on next page(if different E-Mail CICK. l �_. Q-}+• ne+
from the Owner listed above) state or County License C 4;PC6v`/ 71
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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SUPF?�LEME TAL CF NST EG_A N..LIC�N LAWN ' OR,MATION . 1 � ;- WE �r
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ 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 installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
:St. Lucie Counq.,rnakes:no representation-that'is granting a permit will authorize the_permit holder to buildAhe 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.
Inconsideration 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'us"es to another rion-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 theJobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorne before commencing work or recordin ` our Notice of Commencement.
Signafure of Owner/Lessee/Contractor as Agent for Owner ignature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF C 1 �Cl e COUNTY OF
Sworn to(or affirmed)and subscribed before me of Swo n to(or affirmed) and subscribed before me of
V Physical Presence or Online Notarization 7 Physical Presence or Online Notarization
this -1 day of a 2020 by this-_day of 2026 by
C3a�r ec�h (y\Xrf.N- .1-1
Name of persopJnaking statement. Name of persa making ssttatement.
Personally Known x/ OR Produced Identification Personally Known V OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public-State of Florida ) (Signature of ry Public-State of Florida), IL
Commission No.CTG,d 7 (Seal VEVERLY 0.MARSHA LCo ission,Np. r '�jRLY 0.MARSHALL
\1111,111I, as P��..Pu •z ,`� N,tar : ublic State of Flori a
,i°. ;�•, Notary Public State,of F orida ' = ' Commission#r GG 057931
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COUNTER W REVIEW -. R... I
DATE
RECEIVED
DATE
COMPLETED,
lev. 5/6/20