HomeMy WebLinkAboutszloseck permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: cl j :2> I 1\ Permit Number: ______ _ ~-Building Permit Application
Planning and Development ~rvlces
Building and Code Rer,ulatfon Division Commercial____ 'Residential _ __ _
2300 Virginia Avenue, Fort Pltrte FL 34982
Phone: (772) 462-1553 Fax: (n2) 462-1578
PERMIT APPLICATION FOR:
Address: L\9L\ NOX:fu \-nCJ'WD.M, A'\'A 1fort-P\Cf"(,Q.. 1 FL
Property Tax ID#: 14 \ Y -( Q 0d---(')DJ ';) -O'X) -L\
3Y9Y9
Lot No. __ _
Site Plan Name: ---------------------Block No. __
Project Name: ---------------------------
door-nn.. ll\OQ,( l~\>~\a. }f\1 .
New Electrical Meter ___ Second Electrical Meter ____ _
Additional work to be performed under this permit-check all that apply:
/ Windows/Doors
Roof
_Mechanical
Electric
Gas Tank
_Plumbing
_Gas Piping
_ Sprinklers
Total Sq. Ft of Construction: _____ _
Shutters
Generator
Pond
___ Pitch
Sq. Ft. of First Floor: _______ _
Cost of Construction:$ 4'311 · 51 Utilities: Sewer _ Septic Building Height: __ _
Name e\OJ\ :S"?..\0$t\l)
Address: yqyq Nor+h tligbYJl'LL:f t-\1 V3
City: fa<:t P\~'((;_ State: \=-L.
Zip Code: :,4949 Fax:. ______ _
Phone No. ------------E-Ma 11 :. ____________ _
FIii in fee slmple Title Holder on next page ( If different
from the owner listed above)
Name: ro\c ,'<:)(li.,\ ll)O,\Qxnp .
Company: \J\'f\\)\ICffi\W"\ (,()ntfC\U)f\9, \0( •
Address: P ,Q • t)Dj.. \ 1. 7 57
City: furt :p\evUL State: f\...
ZlpCode: 3Y9J9 Fax: _____ _
Phone No { '171 'l S\9-9\0e
E-Mall mwo.,o.ro p@ \oooonoornnnnct((J, m
State or County License C.C:,L l5\ 19\D
If value of construdlon 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.
-..
SUPPJ EMENTAL CONSTRUCTION LIEN LAW INFORM~TION: ;.
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.
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
improvemen s to your property. A Notice of Commencement must be recorded in the public records of St .
Lucie Coun and posted on the jobsite efore the first inspectio . If you intend to obtain financing, consult
with len r or an attorne bef ommencin work or record ' our Notice of Commencement.
Lu.c t ..e
Sworn to (or affirmed) and subscribed before me of
__ Physical Presence or __ Online Notarization
this __ day of ______ _, 2020 by
'\\A ,c,~C\JX l,0cJl ~
Name of person making statement.
Personally Known~ OR Produced Identification __
Type of Identification
Produced _________ _
a vlce::=
Signat¥e of Notary PubliMIIHite otf(1ia;I\! McM~hon
. . Co~m 1GG3l;,v75
Comm1ss1on No. -'.:' ."E E /I e~r1l "Y 19 2(1 • •. 1 xprt :s .. ,, . ,
~--· Bonded Thru Aaron ti
STATE OF FLORI~ L ·
COUNTY OF UU €i
sw..r, to (or affirmed) and subscribed before me of
__ Phys ical Presence or __ Online Notarization
this __ day of ______ _, 2020 by
Mtchael WlllJvop
Name of person making statement.
Personally Known~ OR Produced Identification __ _
Type of Identification
Produced __________ _ /1/4 ,d~
(signature of Notary Public-State . · a ) Nicole
Commission No. ------s , ,; Nov.
TlnA
REVIEWS FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR PLANS VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
REVIEW REVIEW