HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ' �1 Permit Number. d�10 �• v Gg10
...........
RECEIVED
v vY6 Building Permit Application FEB 20
21
Planning and Development Services Permitting Department
St. LT ounty
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: RC ,T r c�t� �= oti►��(
Address: 19SDI 5A,Ly=L.NIO 2:P t-i VLF�2� F( 3` s-I
Property Tax ID#:1361 Go n6o&A (-'>t)0 9 Lot No. 9
Site Plan Name: �� 1/ ►u � `t+��k Block No. l
Project Name:
, '. t.t a his r, s ..�'`"a yr
- =DELEC pESItPT1 .1NF 1NtRK� �z w .
a t
To 2a-yVoy6 F`_.15Trki&, ZOL__ P-ooe-lr-& ow :k� -DECAL-- t,_ 2 DNL4
New electrical Meter Second Electrical Meter
Additional work to be performed under this permit'. check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Pond
Electric _Plumbing _Sprinklers _Generator _XRoof Ftft i Pitch
Total Sq. Ft of Construction: dd Sq. Ft. of First Floor:
Cost of Construction: $ 2`I b�•f Utilities: -Sewer -Septic Building Height: 5z�
gr 3 €�,
O NER L85 L �� , Cf}N'TRACTQ�R
Name ,Sc&sA.wt lbw ct Name: S�-F_,JE J- C}-G7L-b&3&cA 44
Address:,.'95_0� SA ieZ_"._G 1't> L.LL_
City: T i?i�GE State: � Address: _ O t p=A'.a�c /ky
Zip Code: 3_q 5 S I Fax: City: ei RLEt_e_,e-__ State:-L
Phone No. -n-L- _��°) " �72 1 Zip Code: 31-(S8 Z Fax: -2-2- -(al9,5
E-Mail: Phone No -t?2 2 [(0 - 9-6!J:J
Fill in fee simple Title Holder on next page (if different E-Mail U S iot,s&AA ,
from the Owner listed above) State or County License �C6p533 `le3 � /02
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.
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DESIGNER/ENGINEER: T Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone 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 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 r property:A-Notice of Commencement must bi
recorded in ublic records of St..
Lucie Cou a po ted on the jobsite before the first inspection. If u int o obtai financing, consult
with len er o an a fore commencin work or recordin Com ence nt.
Signature of Owne for as Agent for Owner Signature of Contr orj9icense
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF L (
Swo�Wto(or affirmed)and subscribed before me of Swo to(or•affirmed)and subscribed before me of
✓ Ph ical Presepee'or Online Notarization Ph sical Pres r Online Notarization
this by of 20� by this o� day of 200� by
V )
Name of person making atement. Q I Name.of person making statement.
Personally Known OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identifica ' Type of Identific n
Produced Produced C�
off
(Signature of Notar - (Signature of N
KAREN S. NIELSEN KAREN S. NIELSEN
1PPY PUB i� ` pPY PL i
3=0 ;State of FIp ida Notary Public ;=o` °�� State of Florida
Commission No. _ = ommiss4 �a�)GG 207484 Commission No ��g¢�Public
My Commission Expires =y c ommission # GG 207484
MyCommission Expires
June 12, 2022
OF fI
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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