HomeMy WebLinkAboutBuilding Permit Application-All APPLICABLE INFO MUST=BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �a`a I �a Permit Number: ;),O
RECEIVED
d�IIC�DL DEC_0 2 2020
0
g:. ° ` Building Permit Application Permitting Department
rM St. Lucie County
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
PERMIT APPLICATION FOR: G R,,,oa ��svrL>z To,127
PROPOSED IMPROVEMENT LOCATION:
Address:, i0 1;14 V, �� /�i� T/ S /1� %ti c/a 4G 3}9 S 7
Property Tax ID #: V 15-% / - 6?%% 00/ 4 - 0/0 - C> Lot No.
Site Plan Name: ?/LOS i �ZW? Block No.
Project Name: l�ZoSi/�i'1
DETAILED DESCRIPTION OF WORK:
FyCGv�aL �x/sr>.�� e'~e>107- 72 CIZcr,2'2r-�:���G.e
New Electrical Meter —=�` Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical
_ Gas Tank
—Gas Piping
_ ShuttersWindows/Doors
_ Pond
Electric
_ Plumbing
_Sprinklers
_ Generator
_ Roof
Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ /
Sq. Ft. of First Floor:
S , e510010
Utilities: —Sewer _Septic Building Height:
,OWNER/LESSEE:
CONTRACTOR:
Name
Name: STi�41z 9 ,UAL
Address: *!o '4'QyA i214 W.
Company: �ig�/�i�%S Go tss�'IZvGTio.y.��sc
Address: 0, /30x /3ZO
City: T/l,Ae S/ii. Stater
Zip Code: 344,95; 7 Fax: /
Phone No. 27 Z Z7- 9 St>?4
E-Mail: &1A
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
City: J A07S,&�,- ZIZ.09CA State: !=G
Zip Code: 3 el-V — a Fax: 772 33Y o77V
Phone No 279 -: Zrz z193o
E-Mail Tzge-GC - --, eiy"i2 . Grw7
State or County License 6136 07 -07�4 Se
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.
SUPPLEMENTAL CQNSTRUCTION LIEN LAW INFORMATION:
DESIGN ER/ENGfNEER: Not Applicable
Name: Permitrin9 D'Partme
Address: -
S�ele county
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: �ot Applicable
Name:
Address:
City:
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 County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Contrac as Agent for Owner
STATE OF FLORIDA
COUNTYOF Sa'.
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this a day of 2020 by
Signature of
STATE OF FLORIDA
COUNTY OF s * I— P
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this Q—day of D-_c. 12020 by
Skate,\-e 40sk\l s I d-A-.k�v�3
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Pu ic- State of Florida )
Commission No. V.-,G tea M�IEGNENS
# GG023
w r �� :°°0•4.'a_ anY COtvIM15S10N �,or 6, 21120
REVIEWS FR01'="AMN
COUNIi,- I REVIEW
DATE
RECEIVED
DATE
COMPLETED
Personally Known OR Produced Identification
Type of Identification
Produced tL- DL
(Signature of Notary blic- State of Flori -
�,,• �- DEMNMARIE GNE14S
Commission No. P�MYCON M1�8gIdIrj#GG022023
��` ' EXPIRES: December 16, 2020
PLANS
REVIEW I VEGETAREVEWO l I SEA REV EWLE I M EVIEWVE