HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dater 0�• a,\• Permit Number:c. (0 22ko
91T. ILMC • RECEIVED
0 1
Building Permit Application
FEB 0.9 2021
Planning and Developmimt Services Permitting beep ment
Building and Code Regulation Division Commercial Residential St, uc' ounty
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772) 462-1553' Fax: (772)462-1578
PERMIT APPLICATION FOR:
.:� 9,z•z:. aacC� t-�.:-- ar. �..,_ ...WIN`
-�.... _....,
Y. - -
Address: 1100 ✓✓ y1j"' AFT ���..-�� R 3VI"Y,
PropertyTaxlD#: lc/31 7D3- oo`i2 - U06_ LotNo,r
Site Plan Name: aC,e Soh Block No.
Project Name: 75e X sh
g 1
.x._.....z..-•r Viz:._ 3._:._._: :--•_.Hsu•,i".�,.'i.�...':ci."�.,:�
i✓1� p/ ESNC-PeAl, S 1 a -ST
New Electrical Meter Second Electrical Meter
3:z a ''• ,"t. .aeiY...�ssscx... a "'• ae_�?S .-r_�- Z'a � YYsf -'y •- srz,•r'," ..,:., .. .._sue.
;FZx:zar.:.zr?zR.._�"zza.:4;:izzss.IWacri
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: Zzoo Sq. Ft. of First Floor:
Cost of Construction:$ 02 Utilities: _Sewer _Septic Building Height:
�r(e w�-.�+d.. _.-•eiT-.'*.�.:�u. ee�°e+."�a�.� .<....a3�,c ..eti��•.`'- _. 1.:.di�sTr� '.e:��R-'ya"'T..�'�a... 32ki:! - ,�Z:a..__, -^-.sit �--'ii�s_
Name 731�7k -•K c t A e lCn•e 'S;Xg,9k1 _ 'Name: -
Address: 2 -zo ,✓ "151(k S4- ^Company:.
City: F4 pl e r&g State 0 Address:"'
City:
Zi de:.Co Fax: State:
p ��5 y 6
... - - 1.
G
Phone No. 1� ,� - �/y � b �G/ Zip Code: --' - Fax:
E-Mail: p(iok, e_ opme.,.54 . ,✓ Phone No
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License
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.
_ -tom. .�•� ,..,Y.-- _
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 cohsideration 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 concurrericy 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
withlenjcbr n attorney before commenci r-recordin our Notice of Commencement.
Own r/ ee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA.
COUNTY OF COUNTY COUNTY OF
Sw r to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
ysical Pre s Online Notarization Physical Presence or Online Notarization
this_T day of 202f by this day of 2020 .by
�T�
Name of person -making s ment. / Name of person making statement.
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification
Type of Identification .Type of Identification
Produced �`, Produced
(Signature of No ary Pu ' -State of I'on a re of'Notary Public-State of Florida }
Commission No. ,��;Yo+ KAREN S. WE E
�ate of Florida-Not ry Public ion No. (Seal)
CMy commission xpirress
,OF �`` Junu
_REVIEWS FRONT VISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 5/6/20