HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE.COMPLETED FOR APPLICATION TO BE ACCEPTED I
Date: \5 a.� Permit Number:
RECEIVED
O
° Building Permit Application DEC 15 2020
Planning and Development Services Permitting Dep tment
Building and Code Regulation Division
Commercial Residential St. L� le ounty
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
Address: �a
Property Tax ID#: �a ^ Lot No.�
Site Plan Name: �1��'1�70N � ZIA Block No.
Project Name: CviA,�/�
/(, ! CeI7�C�doll G /l�G�+G✓C 036"' � t � v
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New Electrical Meter Second Electrical Meter u
fill ;J
NO
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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:$ f �6� Utilities: —Sewer _Septic Building Height:
n
Y �„•�<.krri'+Wn:' " vrx.srw�-.-Oy4
OWNRESS' ,
N Name: Td 4`v
Address: /0� C tvl��cq7G 12 Company: �'7
City: k1t (1�2� State:_a/ Address: �v s, Nc���9n� ��[iv
City: f�fJYL� Q zh P Stater
Zip Code: 3�h'�0 Fax: y�
Phone No. �� 3 ' �/d ' 741/p Zip Code: � o Fax:
E-Mail: 2"'I./ JX6 d n . Ccc2` Phone No ?7� g2 e" 873
n O O S � �c�1, GOv►►
Fill in fee simple Title Holder on next page(if different E-Mail 041C.-
State or County License
EGG /3a f�3�
from the Owner listed above) C 17 e-
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 Cp4nty and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
wi en er or an attorney before commencing work or rec F in our Notice of Commencement.
Sig ture of Owner/Lesse ontractor as Agent for Owner qgnure of Contractor/L' se Holder
STATE OF FLORIDA E OF FLORIDA
COUNTY OF Sir _-.q c.-"Z' COUNTY OF
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�day of t e.c. 12020 by this V5 day of tC r. 2020 by
5�1n.� Cie•d-c�� ��h,ram �"tro�-�1 Q
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 L l
(Signature of Notary P blic-State of Florida ) (Signature of Notar
,.•• ;YP:.•, DEANNAMARIEGIVENS
Commission No. a-•�•.d GNEo023 Commission No. MYCOMMI GG022023
�; ;; EXPIRES: M-W 16,2020
D M$S\ON#GG6,�026te�s •% OFF��p' Bonded ThruNotary Public underwdters
REVIEWS N o>aa RVISOR PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20