HomeMy WebLinkAboutPermit Application 302 SE TranquillaAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: A - '
Permit Number:
Ca '
Planning and Development Services
Building and Cade Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
� PROPOSED IMPROVEMENT LOCATION:
Address: _ 30-;- S� �iu�N�y. i ` ( /)
Building Permit Application
Residential
Property Tax ID #: 19 �,_3U cal ''7 1 Qou A Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
AIL
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additi nal work to be performed under this permit -check all that apply:
Y 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: $ gibu Utilities:
—Sewer _ Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name i 4in.M -
Name:
Address: `T7
Company: 00 4_) .M -.0 " �JV4
City: I �T State
Address: -,,
( �R
Zip Code: n C 1 Fax:
City: 5jut'- ✓
u_4 Pi5-L State::
Phone No. r '1 f
Zip Code: "' :W 3
Fax:
E-Mail:
Phone No `�'�_ �
j, IL4 /
Fill in fee simple Title Holder on next page ( if different
E-Mail 1z
^`
v i. I
from the Owner listed above)
State or County License
i
tip i; U 1qi?) j J_
If value of rnnetmrtinn k ,nn — ..,.,mo_9 -___
- ------- .,..., ..a.v ..WLMa UN LurlH11e fcemerti Is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: Phone
Not Applicable
State
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:_
Address:
City._
Zip:
Phone:
Not Applicable
Not Applicable
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 aItorney before Commencing work or recording our Notice of Commencement.
Owner
as Agent for Owner
STATE OF FLORIDA
COUNTY OF '2" C ,
Sword to (or affirmed) and subscribed before me of
es Physical Presence or Online Notarization
this jj-)-Y day of F� �,2..s1rc= -228 b
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced 0-rs
(Signature of NqoX Pyt blic- State of Florida }
G,0-So bI Q *APT'&d Phllllp J. Koplan
Commission No. a° (5eWre of Florida
'%, do MY Commission Expires 04/25/2M
REVIEWS I FRONT I ZONING I SUPERVISOR
COUNTER REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
of Contractor/License
STATE OF FLORIDA
COUNTY OF C
Sworn to (or affirmed) and subscribed before me of
--),�Physical Presence or Online Notarization
this JIL day of MO-,, oaJ .O0 b
ell
Name of person making statement
Personally Known OR Produced Identification Az —
Type of Identification
Produced t �� 4•�Z-�'�� �( r3
(signature of Notaryrrpublic- State �,of Florida }
Commission No. V ��� j �)-) ,JSeal) Phillip J.KoPla
$^A State of Florid;
`commission Expires'
''kort�Q commission No-G
PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW