HomeMy WebLinkAboutnew doc 2021-02-04 10.30.All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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V 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
I PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: I Iq I PC ` Aac
Property Tax ID#: 3 Lot No.
Site Plan Name: Block No. (—
Project Name: FK kTiOr
DETAILED DESCRIPTION OF WORK:
f lVP Lv �'�(70w5 i aSia� Q� �(1{ I� Crt }tIr or do�TS I f . Loot S ion tql S3C �_
Alfr, S�1uf#tlS Fb �nS IIZ�
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION;
Additional work to be performed under this permit -check all that apply.
Shutters windows/Doors
_Mechanical _Gas Tank _GasPipmg
_ _ _Pond
_Plumbing( _Sprinklers
_Generator _Roof Pitch
_Electric
Total Sq. Ft of Construction: 1 rl
Sq. Ft. of First Floor: I
Cost of Construction: $ I Utilities: _Sewer _ Septic Building Height: g�
OWNER/LESSEE:
CONTRACTOR:
Name/VyAV-\AL O c7tr$
Na.,. 0-VId wi~(la(a.
Address: ��'I Ne0.Xn,>- IT
Company: Qey> rAl,ii-t LLG
City: FDT-y (��(Iu Stater
Address: fN Sw Dolin C�
�
�9
Zip Code: ��9 Fax:
City: Cal (� State:-
Phone No. ���' �030 9 �—
Zip Code: Fax:
Phone No
E-Mail:
Fill in fee simple Title Holder on next page ( if different
E-Mail rl ,re5idk�iwl Plan a,I.Cah
from the Owner listed above)
State or County License Cb)Gl��'�oq
H value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
if value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTI
N LIEN LAW INFORMATION: .
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
_fApplicablel
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY:
Name:_
_Not Applicable
Address:
City:
Address:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to no me woI K anu 1—id! a 11ill 11-1
—
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
structure. Plea a consult with your Home Owners Association and review your deed focovenants
any restrictionsawhich ay apply prohibit such
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an at$orney before commencing work or recordinglyour I otce of Commencement.
as Agent for Owner I Signature
STATE OF FLORIDA I STATE OF FLORIDA C —
- Uk Oil C
COUNTY OF COUNTY OF�{
Sworn to (or affirmed) and subscribed before me of
Phy ical Presence or online 01anzation
this day of A 1 by
Name of person making statement.
Personally Known
Personally Know OR Produced Identification / Type of Ident f cal
Type of Identific Tit yd f 0 1 _ vrndiired
Commission No. l�''%�1 s c E ct�y t I Commission No.
Sworn to (or affirmed) and subscribed before me of
Physic Y Presence Ary Online Note Yzation
this l( da of ✓ (.�202� b
Name of person making statement.
Olirdu ced idlentification
REVIEWS FRONT zz, z 6R OR PLANS VEGETATION S 7�JI�JLt" IVVRUvt
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COUNTER REVI FBI REVIEW REVIEW R Ps REVIEW
DATE
RECEI
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