HomeMy WebLinkAbout6804.permit.appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -3, -�u ; \ Permit Number:
LI�i�C� -�
e. � C D a Building pp Permit Application
Planning and Development Services
auilding and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION: I
Address: b�< a q
Property Tax ID #: l O — (S o LC O ' — C� Lot No.�
Site Plan Name: C Block No.
Project Name: �� �ar �Zce O"
DETAILED DESCRIPTION OF WORK: i I
C� N, Pt e e -t t cr �? e —1R�o F S f ti rn S BSI Py
fir�,l�r
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 ZRoof Pitch
Total Sq. Ft of Construction: �' 1 U Sq. Ft. of First Floor: -\, I q S
Cost of Construction: $ C) 6 Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name \ 0.Chet\ e- 0J
Name: Do' (r e\1 (. etj�S
Address: LlC, U
Company: i_oo'
City: State: FL
Address: n \ C (• 131
Zip Code: 3�. l4, Fax: Al `r �
City: L^,� (��� State:
Phone No. E(Q W bl t( q
Zip Code: '� 11 Fax: Q c 1 (b,3
E-Mail: L /, .ir
Phone No L/ 1 `( (W 1/if °C)
Fill in fee simple Title Holder on next page ( if different
r
E-Mail C' -> cv ^}, FL e )A,,,
from the Owner listed above)
State or County License cc( ()3 1 P
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State,
Zip: Phone
City: State:
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.
__
Signature o wner/ Lessee/Contractor as Agent for Owner
Signat a of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF � crucx
STATE OF FLORIDA / ✓ C
COUNTY OF '�\ 1.
S r to (or affirmed) and subscribed before me of
to (or affirmed) and subscribed before me of
h1t,�ical Presence or Online Notarization
thi `stay of M�' �c 2020 by
PhY,sical Presence or Online Notarization
this `Uay of MAC 2021 by
n
Name of pers n making statement.
ement.
Name of person mZOR
Personally Known OR Produced Identification
Personally Known Produced Identification
Type of Identification
Type of Identification
Produced
Produced
.' coe
(Signature of Notary P
..�n � No"PuDlie 11M� of Florida
Commission No. ip µytt,T �O14�
a E)Ins N19r=
(Signature of Notary
yR+� ►�Wyvy Public 31M� of Flonds
Commission No. 'y Ma=8G9147W
a ME irn OOJ1M20if
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20