HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE C( 'PLETED FOR APPLICATION TO BE ACCEP'_,
Date: Permit Number: Uyv
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 349821
Phone: (772) 462-1553 Fax: (772) 462-,1578
PERMIT APPLICATION FOR:
RECEIVED
PEAR 01 2021
Permitting Department
St.� Count,!
PROPOSED IMPROVEMENT LOCATION: .,
Address: 07 S TND'i AN TetiSe►4 BRA` f-I 3)4% i
Property Tax ID#: 1.4�D-1_ la®;—(D01- 00o/0 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF"WORK: m6l1Q1 'V ,1ZI,DZ'o.iy
�Ul-1N A �02 A ,Xk\U r, /7z,/— LID�
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 x►stru�tion_$ .- � Utilities: — Sewer — Septic Building Height:
OWNER/LESSEE:
CONTRACTORS'
Name te
Name: (niter �tle� 1�1A��A
o ',,a
Address: %.S J .�+'�/MAA) /'
Company: Co Any Mf}�fl C-
City:< -AJ5?`7AJ 969CH State: R.
Address: C�T
Zip Code: �9d� 7�2 Fax:
City: Po, S� �-`�' State:
Phone No. ��Y —. ��" �9�
Zip Code: 3`I `l &L Fax:
E-Mail: JL!fy 6 L i';rr Y/0 �����f. Q�
Phone No -7- �
T—
Fill in fee simple Title Holder on next page ( if different
E-MaileMIj , DA 13 e Li -A 4o0 M
from the Owner listed above)
State or County License�l�
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. J
SUPPLEMENTAL CONSTRW&ION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
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 Coupty 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 recording vour Notice of Commencement.
Signature of Ow r/ Lessee/Contractor as Agent for Owner Signature of C ractor/License Holder
STATE OF FLORI
COUNTY OF 0_,,'-�l I'1
SworVto (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this 12Nay of n J 2020 by
Vid i''11 '1n5,
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced Fi c2 a- ID L.
1 j (Signature o0otary Public- State of ��ie48�� MARyLEE MarnS
qV t MY COMMISSION # GG of
Commission No `� g) EXPIRES:Marc7'6,202
Bonded Thru Budget Notary SE
STATE OF FLORPA "
COUNTY OF l c Ltd
Swo to (or affirmed) and subscribed before me of
7Ph 'cal Presence or Online Notarization
this �ay of 2020 by
Name of p'e son a7OR
ement.
Personally Known Produced Identification
Type of Wentif'cation
Produc
(Si nature of Nota' Public- State of Florida )
4s�g :;o}� "^ iI SHERR IL69tIIA.
Commission N • •-GOV174, (Se .)
ifVICeS � . ;ii;?�'' �I�1�Nr�PF�itsirYYL9ac�n
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE MANGROVE
COUNTER
REVIEW
REVIEW
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REVIEW
REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/b/ZU