HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2 `% -d 0 Permit Number:
Planning and Development Services
SEP 1 c.: 2020
Building Permit Applicatio'�iS'_t'__-'_'LU'cie,,Qounty,
iiing Department
FL
Building and Code Regulation Division Commercial Residentia
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: T"i D-vo'i-' Lo�'l
Address: i/gog M146IVD L---19 14V,--A1 M5F , Der" f 1 eRCr , YCL 3!�/ 57'Fa
Property Tax ID #: -_ �G'L'L -7-:6 .34yay - 501- 03�l�- coif - 3 Lot No.
Site Plan Name: 1`-44 i;D97AA-25 Block No. '71
Project Name: /10,464 12-/'/O6gL
�A4Me .z/V 04i2Po2T� eo eVyz'2 i 3 W N bows -I-n on 5 -
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52Aln 129 12e5�i D5'6 �
New Electrical Meter Second Electrical Meter
C{NSTRl1CT�EN INFO# ��� &�
.j,-ar.--.. e R'.ATI�� � 9WP <,�„ L - <<•E. 34).w S �f u:,�
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Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank —Gas Piping
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ / 0, 0-0 U - 12 0
✓Shutters V Windows/Doors _ Pond
Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWN LE S ... �a
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Name �DA/A%#,fA1 YEWM
Name:
Address: J-Hdg lq,4iI/06s r 1 vie-,, U9
Company:
Address:
City: rD pie2Gg State: 1�L
Zip Code:.499,P Fax:
Phone No. -77d ' 4/,k- h9d Jf
City: State:
Zip Code: Fax:
Phone No
E-Mail
E-Mail:_jvr7e�,7��ie,yr,F✓�a �rce'$'C� Ry�eci�� CpN�j
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License
IT Value oT construction is /buu or more, a KELUKUED 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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EJt�P #UlE
T L C}�ISTJ � ltJN L EN LAIN tt
t✓t R(1AX TaQN:��
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: LI/Not Applicable
Name:
_
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: /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 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
with lender or an attorney before commencing work or recording our Notice of Commencement.
Signatu o wner Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
Sw?,n to (or affirmed) and subscribed before me of
Ph sical Presence or Online Notarization
this day of , 2020 by
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of 2020 by
Name of person making state nt.
Name of person making statement.
Personally Known c/11 OR Produced Identification
Personally Known OR Produced Identification
Type of Identific i n
Produced )
Type of Identification
Produced
Gf�
(Signature of Not r Public- State of Flori )
(Signature of Notary Public- State of Florida )
Commission No. ; <PaYP¢,; AUDREYB(���PPUn�yn HR
OMMISSI�QRI G
Commission No. (Seal)
EXPIRES: March 6, 20237I
„oFF;,.•• Bo
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REVIEWS
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5 6 20