HomeMy WebLinkAboutBuilding Permit Application r
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3'' 1- g,\ Permit Number:
lq�lr. RECEIVED
O BUJ ll
PEAR 0.1 1011
Building Permit Application Permitting Department
Planning and Development Services st. Lucie count
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: Iv I>
PROPOSED,IMPROVEMENT LOCATION: ..
Address: /0 t to S c,<e D,
Property Tax ID#: �/�/ �'/`�'G(�G 00 Q Lot No.
Site Plan Name: �r �e+� T'S c7�� �O 3 - Block No.
Project Name: I I�retiaeQ�.
DETAILED DESCRIPTION OF WORK:
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 _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 4`7 Utilities: _Sewer _Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name_ _ c Wl k e I `e V(C Name: j�®61_e..r' ` o.; 1e_v' S
Address: t 0 L{/d S OCe4 (v of Company:_P(3 k_'J•V_V'S Y" f %-, 4 e
City: MNCA'15 c 6-4441F State:L Address:30�) Sc;-' 09all-kick c4 6�
Zip Code: Fax: City: l� �yK Cc :�e Stater
Phone No. S-S(57 3(q- g �: 70 Zip Code:-T`/Q F0 Fax:
E-Mail: , h e,- 1.e Q ro cA-e 5�r c � r r. CC/vw Phone No / 7 5-40 a
Fill in fee simple Title Holder on next page(if different E-Mail /vim 1 K, ,�
from the Owner listed above) State or County License C FC a / ' '
LIfvalue of construction is 2500 or more,a RECORDED Notice of Commencement is required.
lue of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
r
SUPPLEMENTALCONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _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.
I
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 our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Cor&actor/Licens-e-1467cler
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF _VG e COUNTY OF S-� L` oc I e
Swr to(or affirmed)and subscribed before me of Swor o(or affirmed)and subscribed before me of
Physical Presence or Online Notarization tf Physical Presence or Online Notarization
this 1,k day of Ae blra^fM1i 202# by this day of JZart> jL%J ,2020 by
Q�In� PcS�lrr.S ZoZ� I(Z>o�er-4- P�c-r 5'
Name of person making statement. Name of person making statement.
Personally Known_I>C OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Sign ure of Notary P 1' - a Florida.) (Signature of Notary Public-St
�u'•• ONALD JAMES NARBUTAS
►*�'ti:°•. RONALD JAMES NARBUTAS '. AUlUd
k.'.; Nota Publlc•State of Flora a
Commission No. �; Notary 0111)State of Florida Commission No. '�kW,'Js (S�aWission B HH 028442
Commission M HH 028442 a:R My Comm.Expires Aug 5,20
My Comm.Expires Aug 5,2024 5onded through National Notary n.
oncea roug a i na otary Assn.
REVIEWS FRONT ZO N PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.