HomeMy WebLinkAboutBuilding Permit Application FFFAll IN O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ` a,� a ` Permit Number: -@'NI'0-45sn
9 r.
RECEIVED
Building Permit Application JAN 26 2021
Planning and Development Services 9ormitting Repertment
Building and Code Regulation Division Commercial Residential St. Lucie aunty
2300 Virginia Avenue, Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
�.R ,i�-m'v'6-. 4.� 5,�'rz: r-
�r r r 7K rai31� �+': iF v i�F y y`. rq 3y
PRQP�SED IMP�RO RIVIENT LOSCATT1O�N= ,�� 4 i_,s F n y , a k�
..... «. r_'�.�.:.hr,. _ .c.. _ .�.? ,.'t_: <,:f,�.9...: ...i�. fi':, `'.C.:.�.
Address: 4" 4-(-,_oe - C - - �rP
r
Property Tax ID#: c3,��+1 dd�d "d bd' Lot No.
Site Plan Name: �..n�1 �C)�l� YhU('j t �. c I�QG Q Block No.
Project Name:
+±YDd'.E��fTi.YrA?!:?..L:[L`aS E�k5''_Dtr:,'a 7rtF.�14,.,:rY�.-.*-..>: ::s�,'�i.-..+'i�-c„�',.:-✓,..s�.h.`.},fi,R..,:I;uC7�>'�44y�_,. ,:fau'r r Y_r���.�.Y�'�+�L."s'.',_.,+n„;%� n 1__�''./,."aS uL3,�-.Y-'H ',Q��',•.•`_,-.�cN--�L`'`.4,aa.�:..L "{. & n' ' n g'
rONWODUS.CRfT aF
3 New Electrical Meter Second Electrical Meter
;'`;'F: .,y..fit- rr,"C' .-.ci€:t.ra x+J!',:gj: E.Frtt'.�a'�kw t5\'•*-, ar.,�.sAFri
,+u*a!,'4r 3'tu ns ,-n7'x.-f: 'rpm-..';•`,n ,,;^ ..; +2 x. ez3.•'�tt._ ` L",' y.:,;,.' -r. .^•.�s..... x- -.x.r"i
� ..-� �:-'�',�dr�.,�.,-_'b"_z�L.•.�`:�r s.x=��nrr.,...`_��.""s�..�.:7[,f,�._ v�� 1'°1 r �" may,
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Pond
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: 000 • O® Utilities: _Sewer _Septic Building Height:
„4'"a S' CFu.S�: �ii•:�.;:�.iy:6�':'.� u.�L''+/ f FMG�Y t' R � )i —
c •-�•+,y"`ai,:s:.>.:,a s*.r,. �.+' 3e6 't"T �{. -'d^{?Fw"._. u� .u7.y�t^%+�
OyWNER/LESSEE` n fY,� a x!+ �`,
:'.`I>...K.:3✓�ti�:a.+;r?�„c...+!A>_� 7y. --+K�2tSt�,'A;1r� ,.Su..s,�.�Sa�*_i�.asF.�%��,� �L'±..3�3. ,,..t'�.'�G,���:_ ;.::�u.9-"r3,r-'.r,:l-�finl.�Wr.rt; ,.r'`t���t.,_ t"-t�X E +a a ��X� 'r wva+ :x,.:
Name Name: �LoOL Y11L Or"i
Address: Company: 1% , G8n_er00 CDYAYGt/,{i 1rf 117ic
City: State:— Address: 3-2k �z YniuOL l J4,6-
Zip Code: Fax: City: P"E—- Kai ce— Stater
Phone No. Zip Code: '3L444?;; Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail +n�r'rp�S 0 A 0). raw-)
from the Owner listed above) State or County License T—k0'f CLO-1—
C. 5
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.
k'ry .�"^rs£-` ;�"iC'w„• w:.G: _"_"7':i.-"r- •�' 7tr•..h.ti., --� ^ .'•- .� 4�i'w .a+:� E�'°+'w � +'•��.,�".��5�;
fSl'JPPLEIVI;EN7L CO�NSTRIJC�TSLOrU ENLAUV_l O 1UI ONg � x:7 >
.'S-.� -:: a»S'.k., ': ,:vf 5�.`vkF:x!..sK�•{',�„�--..'.�^,.:'�+ti5 .'s4c. ��.",c?�:urx,.y. �es.w1:'�S.i
�sR- s .e,'24 ezru« +3 '
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 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 l 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 le or an att ey before commencing work or recordin our Notic -f Commencement.
Sign u of ner(L e/Contractor as Agent for Owner Signatu o tr o cerise Holder
STAT LORIDA STAT FLORIDA
C 0 U OF S�r- L y - COUNTY OF 1
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presence or Online Notarization Physical Presence or Online Notarization
this:Co day of 541"^ 20211 by this J day of 7541--,- 202L\ by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
T p of Identifica 'on a of Identification
P d ced �- l.. r duced
Y P• 1
(Si na re o ota 'c` $i �t "� ( i ature of Qyi� tbli - tl�fl )3 11NG
N RA, A41NG 'If ,: M COMMISSION#G 275Q60
MYCOMM1SS10 GG 27,rsr 1" a= EXPIRES:Decemb S7 22
ommission No. `.'r•... °:' EXPIRES:de Commission Np.`-T r• •e¢
BonrledTryN MoG�ry eft?0, t. Notary Public Undanvriters
__- Public na12;wrfl::
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.