HomeMy WebLinkAboutBuilding Permit Application All APPLICA LE I FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED {
2- Permit Number: `o L
Date: 3 RK-51uE1)
MAR 1 1 2020
0
° ' °° J21 Building Permit Application Sr, Lucie County, Permitting '
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:
PR®}POS®, I PRhORMNTLl'
Address: , Ct Q 1>LCX A)S QA) i'z' C• Z-
Property Tax ID#:_ �l-/T.S _�zy 6 0 zi- DOD• 9 Lot No. I
Site Plan Name: ()L 4�14No &/Z Block No.
Project Name:
®'ETTi�•��D,.D. GR •TfO�N O i® K. _ _ �:F,
^,�'�• ` ram-'''�.' :x"��r.?'•{'i-.ti:� �+`,`'x..t�3?�'-� *- -
t�'� Car, ev q n7 �sW s,Ae or /LC,d2 4,T' ,ZX1eUsio.4 nti�/- e--elS?Yw�-
�em C&Lv 11 04J b1E rui ev1C'�OSvL2���
c7 t t 2 A�
New Electrical Meter_Second Electrical Meter
10O STR'. CTt}ON�I°f�IF®RIS/�AT'nni � .7 N
>r� ,. 3�• --' ',":`.Fed? Sta ?txax.L_,3�r 'U.�a�v.' fir° `�.2f. -• ;c.,.-,,,,�r8 .` �'er�-
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
PAS Total Sq. Ft of Construction:I 1J)-'ZS= 425 Sq. Ft. of First Floor:�,
Cost of Construction:$ Utilities: _Sewer _Septic Building Height:
OUtlN,ER%LESS �� F W5 TOR`' , 3
xae4str. � T�� �r ._k_
Name 7 OS&19/4 W �L=�LC�N �1L- Name:
Address: �r� r�rCkl/U /� 7-'L14- Company:
City: Pn/L% S4;� J�/� State: FL Address:
Zip Code: State:
'�g•S"'Z Fax: -�� City:.
Phone No. Z/ - Zip Code: Fax: .
E-Mail: J ti V4U 16' !1m,1 174 Phone No
v
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
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.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name-
Add es
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 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.
Signa Cre of Owner/Lesse ff
ontractor as Agent for Owner Signature of Contractor/License Holder
ST ATE F FLORI�A� _ STATE OF FLORIDA
COUNTY OF " yr �°1 ,1 COUNTY OF
Sw/to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presence or Online Ncitarization Physical Presence or Online Notarization
i-hli—sl k day of 2020 by this day of 2020 by
Name of person aking statement. / Name of person making statement.
Personally Known OR Produced Identification �// Personally Known OR Produced Identification
Type of Identifica#m Type of Identification
Produced Produced
(Signature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida)
KAREN S.(N� SEN Seal
Commission N .:PaYP�B;,, roa Commission No. (Seal)
� �` Florida ry Public
* Commission # GG 207484
111iiii�%% June 12, 202
REVIEWS ISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
�ev. 5/6/20