HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICCA LE 119FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `"l 51ruz Permit Number:
44o d�C�IlC
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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:
I PROPOSED IMPROVEMENT LOCATION: I
Address: Xx K 5r't cc-d il?d . Fo ri Pf em c i FL. 3 4 9 L) 5 I
Property Tax ID #:G2 Zl o o - 6M - 000 - "7 Lot No.
Site Plan Name: Jf 1 Ll C'-t (,y-,4 Block No.
Project Name: Sm.th 2ic,hc r-d
DETAILED DESCRIPTION OF WORK:
rV e, -- mcb; Ic hn me -Fo be Ivs ilcd.
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 _ Shutters -Windows/Doors _ Pond
✓_Electric Plumbing q_Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction:-1-Bi9-E3, I Oto Sq. Ft. of First Floor: Ly'mp I "I JrO
Cost of Construction: $ i LI Lo, S 3', Utilities: -Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 12rc_Yt&c-6 � "rcc 5_i4-"
Name: ►Ju+hrz,r ""For-8Address:
kXY 5Naccd ed .
Company: Palm, l-I-o.rbor
l+omcs
City: F ,+ Pr c,"c f State: PL.
Zip Code: 34445 Fax:
Phone No. -7-72-514 - 231 z-
Address: l.no5 5. Fro,:.b
e 2co-8
City: Plcc,,i,-} r,-k4
Zip Code: 3351a 3
Phone No 813- 3Lc5-
Stater
Fax:
38)-7
E-Mail: n-icdrl[ma_Vhari8232yG.hoP. CoM
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail N ha.y Prd AD
oci—harbor.coro
State or County License
S N 1122 DS 2
It value of construction is ZS00 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:
City: State:
Zip: Phone
FEE SIMPLE TIT} HOLDER: _Not Applicable
Name: � I�
Address:
City:
Zip: Phone:
MORTGAGE COMP: _ Not Applicable
Name: In
Address:
City: State:
Zip: Phone:
BONDINGXO�VIPANY: _Not Applicable
Name: V I fr
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 attornev before commencine work or recordine vour Notice of Commencement.
Signaf6re of Owner Lessee Contractor as Agent for Owner
Sign re of Contracto /License ter
STATE OF FLORIDA
STATE OF FLORrA
COUNTY OF 2y�,(7
COUNTYOF II// L D
S orn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Ph sical Presence or Online Notarization
✓ sical Pres ce or_ Online Notarization
this day of v 3 2020 by
this ` dray^of 20l20 by
Name of person making statement.
Name of person making stateme .
`
Personally Known OR Produced Identification
Personally Known ""gsOR Produced Identification
Type of Identifi anion
Type of Identification
Produced C—
Prod e
UN
(Signature of Notary Public- St Ida) TAWNYABROWN
(Si ature of Not - ate ojtW I)AVIS
7",
_ MY COMMISSION # GG 91
242 "'fie' MY COMMISSION # C 912023
Commission No. / %�'/`;:,,a.f.,.3e��{PIRES:Seplember29,
9onaea Thru NNary
2�o ission No. IRES:Sepl(s9L�I�9
Public U
aonoed Thru Notary PuNw nderwrllon
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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