HomeMy WebLinkAboutBuilding Permit Application'All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ��' O v ' Permit Number:�-
-4 31 a4
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: - ���p�! C�-
PROPO5ED IMPROVEMENT LOCATION
Address: �Y1 CaU� Y-i L Sfi `�_ a C,t-C
Property Tax ID #: W S6- OL I - ODD- Lot No.
Site Plan Name: 3` y)ra k Block No.
Project Name:�-
DETAILED DE5CRIPTION.OF W' ORK,
RECEIVED
NOV 17 1010
Permitting Department
St. Lucie County
New Electrical Meter _� Second Electrical Meter
CONSTRUCTION� I N,FORMATION:,,
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: / 6M Sq. Ft of First FI or:
Cost of Construction: $ Utilities: 1Gewer�%&tic uilding Height:
OWN ER/LESS`E�E _ ,� ,
CCJN�TRACTOR '.• .
Name 'f)0. R
Name: e;, eu�
Address: - 1ss -)
Company:
City: eYGz_ State: _
Addr ss: 98% o»s
r
City: 91 ��� Stater
r��l t�
Zip Code: ,)`ICl��% Fax:
Phone No_
Zip Code: 6�3 C�S) Fax:
E-Mail:
Phonea�r -l- )'_n
Fill in fee simple Title Holder on next page (if different
E-Mail $Y10Y( s _V
from the Owner listed above)
State or County License it-Z�,Q'3V2 R)
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.
J
SUP PLEMENTALCO'NSTRUCTION;LIE-N LAUD INFORMATION
DESIGNE /ENGINEER: _
Not Applicable
MORTGAG CO PANY: _ Not Applicable
Name: I'- �-c- rLi C_-
Name:
Addres : %G� �rtlt,
e
Address:
City:
State:
City: State:
Phone
=1 15
Zip: Phone:
FEE SIMP TITLE HOLDER:
Not Applicable
BONDING PANY: Not Applicable
_
Name: fW--E
Name:
Addres . c�U 5 j
L-
Address:
City: a@�
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 your Notice of Commencement.
Signawfe of Ownek Lesse Contractor as Agent for Owner
re of Cont ctor/L ense Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF ' oOuk V"W_% -
COUNTY OF S&A W69-
Sworn to (or affirmed) and subscribed before me of
Swo;n to (or affirmed) and subscribed before me of
Physical Prese ce or Online Notarization
%*r- Physical Presence or Online Notarization
this � day of OVev&eT 2020 by
this g day of NNFO 2020 by
:4 moyxkS
Som%4 t kyorks
Name of person making statement.
Name of perslon making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Mloheel
Notary Put
IlgSignature of Notary Public- State of FloridaWE191't;
(Signature of Notary Pu lic- ate of Florid s Notary Put
State of FI
Commission No. (SWCommilH
S
da State of R
ission No. 0 (ComrnNHHCf
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i9�Expires 7/
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Expires 7
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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