HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ' 04. 2-0 , f Permit Nu.
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Building Permit Appli
Planning and Development Services
Building and Code Regulation. Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
K 'I1:1
CEIVED
lion
NOV 18 2020
Permitting D artment
"LYReW FL
PERMIT APPLICATION FOR:� LLJ
Address: Z 1 (D �D )Q JCL �a (3)YO`
PropertyTaxlD#: Lot No.
Site Plan Name: Block No.�
MENRIA .�
New Electrical Meter V Second Electrical Meter
COaNSTRU'CTIONINFO�R�IVIAIO�N"'
AdYona ork to be performed under this permit- check all tfydt apply:
nical riumbing
Tank _ Gas Piping y/Shutters Zindo'ws/Doors Pond
c _ Sprinklers _ Generator Z Roof Pitch
Total Sq. Ft of Construction -2-1-7 1 Sq. Ft. of First Floor: L fip
Cost of Construction: $ 11 S . SC)O • C�J Utilities: _ Sewer Septic Building Height: _1
' tN4 ;> v:r�f,� "Sy s "
OWNER/LESSEE:, Y �.� 3 <rF
SW5
r.e.�t"'a` Y+R'fe. x�r�.,r-+x,E if �F'ix>�+, i w,k
COIVTRACT®Rr:, d y $s� <P t.
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'
Name R)_
Name: PACW-t DC)
1
Address:
ompany: V4C" ,FL•
LLCj
Address:'3C�Ql C
LrAV_^j4Y'•S'le
City:NOr=SS State:QA
Zip Code: 3 00 7 / Fax: 1nC�
City: WT=6 ,
State:GA—
Phone No.Q�)y) . Q 10 • lP l8 2Ci
I
Zip Code:
Phone No 3ca .Z
Fax: A!�
E-Mail. V1i�
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E-Mail
Fill in fee simple Title Holder on next page
if differen
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is requires.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required. .3 ) 9,
IM
SUPPLEMENTAL CONSTRUCTION LIEN. LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name: .Mu[hem &Kula
Name:
Address: 30d Brooksi8e.Aye
Address:.
City: Ambler State: PA
City: State:
Zip: 19002 phone (216)soh-anni
Zip': Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:.
Address:,
Address:-
Cjty
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-Coun makes no representation that is granting a perm itwilI-authdr;ke-tf a permit holderto build the subject structure
which is in con Ilct with anyapplicable Home Owners Association rules; ;bylaws oe and covenants;that may restrict or prohibit such
structure. Please eonsult.with"your Home'Owners Associatfon and review your deedfor 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 Countv and posted on the iobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or record i.ng,your Notice of commencement.
Signatur _ ;; weer/ _essee/Contractor as Agent for Owner ature` of G `fracfor/,License Holder
ST ORI,ppA S. FFLORIDA
COUNTY OF Lo rev-rd COUNTY OF reyaJ221
Swor to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this 12�L#d'hy of fyOlferni5P , 2020 by
cy-\0-e" 41 a -
Name of person m ial(ng tement.
Personally Known OR Produced Identification
Type of Identification
Produced,
Signature of
C DOW
Commission
REVIEWS I FRONT {ZONING
COUNTER I REVIEW
DATE
RECEIVED
DATE
COMPLETED
Swo to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
thisIfay of WQLA)nryle r' , 2020 by
Name of person maMn �atement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of N
Commission No.
tHelow Nowy . PUWC"gtiti d FWW
C D° a�oo 0
SUPERVISREVIEWOR I REVIEW I PLANS VREV EWON I SEEV EWLE I M EVIEWVE