HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE C&o—_ fED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number: e�10] ' G l
9 r. L�l�1�Q� RECEIVED
O
p Building Permit Application DEC 16, 2020
Planning and Development Services Permitting Department
Building and Code Regulation Division
Commercial Residential- Luclunt•,
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: SS20 - - 20se) tJoczi r src ' 3u Z
Property Tax ID #:OFTQj' �� ����'00D- Lot No.
Block No.
Site Plan Name:
Prniect Name:
C C - 'OD-i1r2.000 I now,- C f` t
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit _ check all that apply:
c� Mechanical _ Gas Tank —Gas Piping _ Shutters Windows/Doors _Pond
ti
_ Electric — Plumbing — Sprinklers _ Generator _ Roof
Pitch
Total Sq. Ft of Construction: �� 00 Sq. Ft. of First Floor: 7 G 00
Utilities:
Cost of Construction: $ 30 006 crn _ —Sewer ✓Septic Building Height: 14,00
State:
Zip Code: 2 Fax:
Phone No. `712. -'Z 40— 3 6 4 2s
E-Mail:
0
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: - ' KQtr)L
Address:268'�'
Cityaz=i �V,:!'Lvci State: EL .
Zip Code: 34-g S "I Fax:
phone No 56 r A'R c 53 9' 1
E-Mail 6o i or it
State or County Lice e CGG I S' I
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.
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: — Not Applica ble
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 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.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holde5F �� -- — "-
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF S4 VA«fe,A�
COUNTY OF
Sw�o (or affirmed) and subscribed before me of
Swo o (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
'DQ.c"
Physical Presence or Online Notarization
(5 Q<Z-- 2020 by
this_ IL day of 2020 by
this day of
,a Cs4kI (r�,
RaI ( COS41110
n,I
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
of Notary P I - State of Florida
(Signature Y )
p�evc
(Signature of Notary Public- S e of F ida )
L FRANCESV.JOANS
°tr?� PRANCES V. JO
Commission No. a�i�(o� * I� Commisslon#HHO
S I ( 3r°s-g "% mmission # HH 024361
4�lmmission No. l� �P *�Sea6piresOctober 29,202
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a Expires October
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REVIEWS
FRONT
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
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DATE
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DATE
COMPLETED
Rev.5/6/20