HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEP'
Date:' :Z.(�j CxQ Permit
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Building Permit Appli
Planning and Development Services
Building and Code Regulation Division COITImel cUi
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
NNNENNWEP'--.WuAWrWK ' 'I
NOV 18 2020
tiladtting Depar, ment
St. Lucie COU y, FL
PERMIT APPLICATION FOR: r*Wi G he, I i
51
1-
Address: -7 tQ 0L4 Pennq L_ . nrf_"'
Property Tax ID #: 130 l' to 07 ' Q 3U10' 000' S Lot No. ip�
Site Plan Name: )—CL LC:eLxJ0C�N .pQA�—. Block No. fa
Project Name: 1K.�) OLd It> IJ t�yY�,t,,� �S
New Electrical Meter
Additional work to be performed under this permit— check all that apply:
_Mechanical Gas Tank _Gas Piping utters Windows/Doors _ Pond
ctric Vlumbing _ _. _Sprinklers _Generator Zoof Pitch
Total Sq. Ft of Construction: _ �® s't Sq. Ft. of First Flo
Cost of Construction: $ 1 0 1 ` f Utilities: _ Sewer Septic Building Height:
'+OWN'ERA/LES`SEE�r'��`°��'>'�
CONTRACT®Rt ,� t `� �� ru
T..,if}.i..i+''k`i`.ai4' '�!.
Name W,—i)A TfL i—t_fi
Name:
Address:30q l &01 P�S ICy r.Lck' W
Company: V!'Q' i f L t
City: fyGYC MbS State: GA
Zip Code: :3 b 0)Z l Fax: &AA
Phone No.ta'L(�i . LZLe Q
Address30QI"COOW2''LU0 66 X0
City: A.43'r_)?%556 _ Statd2^
Zip Coder OFax:
(rI f
Phone N� Q
E-Mail: _
Fill ip4ee simple Title Holder on next pa if i erent
from the Owner listed above)
E-Mail
State or County License CGCI !j
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 CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name: Mulhem&Kulo
Name:
Address: wd grookside Ave
Address: _
City: Ambler State: PA
City: State:
Zip: 19002 Phone (215) sas-scn,
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 Counttyy makes no. representation that is granting,a permit will•authdHie'tHe permit holderor to build the subject structure
which is in conflict with any applicable Home Owners Association rulesi:bylaws or and covenants that may restrict 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 record Ih your Notice of Commencement.
Signatur weer/ essee/Contractor as Agent for Owner
COUNTY RIID
CI'FO�SYe�rC`.lral
S rn�h'�alaoPfresence
r ffirmed) and subscribed before me of
or Online Notarization
thisy 1V0V'&- � 17A . 2020 by
Name of person maki tement. IJ
Personally Known OR Produced Identification
Type of Identification
Produced•
(Signature of Not T —
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Commission No. Co M 029MG
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REVIEWS I FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
older
COUNTY FLORIOr&M r�J
COUNTY OF k�
Sw rn to (or affirmed) and subscribed before me of
ical Presence or Online Notarization
this ay of I&L��� . 2020 by
Name of person making tement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Nota -L �ydF►o"
112i
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Commission No, /
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SUPERVISANGRO
REVIIEWOR REVIEW I I PLANSVREV EWON I S REVIEW EGETATIEATURTLE I M EV EWVE
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: —Not Applicable
Name: ilty L r'&rV-% jC.a% 19:>
Address:150G try
City: 1M Eta' State:
Zip: J4gCJ0 L Phone 4
MORTGAGE CO PANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone: N11—
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
BONDING COMP _Not Applicable
Name:
Address:
City:
Zip: Phone:
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-er an attornev before commencing work or recording your Notice of Commencement.
Sign re of Owner/w 1eelContractor as Agent for Owner
f Contractor/License Holder
SigrEOF
STATE OF FLORI'F--ykU(1VKA
ST INDIANA
COUNTY OF
COUNTY OF HAMILTON
Sworn o (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Presence or _ n ine Notarization
this day of 2020 by
this day of 2020 by
Name of person making statement.
Name of person making statement.
Personally Known V OR Produced Identification
Personally Known V OR Produced Identification
Type of Identification
Type of Identification
Produced
C4 r�
Sign ure of Notary Public- State of Indiana )
Si " e of Notary bli -State o o
JAY ► No ry Public State of F
Commission N ON (SS'
® any L Rubino
Yvonne M. Senesac
Co mission No. 0664315 ;��'•"••••?cf;•:: Hamilton County, IN
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My Commission GO 27187
My Commission Expires
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Expires 10/2e/2022
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PLANS
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MANGROVE
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