HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:�_ I 1� Permit Number:
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Building Permit Application
Planning and Development Services /
Building and Code Regulation Division Commercial 'Residential V
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: �A qyq NO"-1 Vt Cah��.�R I a AIR EQV-+ Pi Y-U FL 3y CI L�cl
Property Tax ID#: I y I H - n U�,- 00-1 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
�n��ollkn(a n (es tnk,\A- 51ic�VknCA C�IaSS c�nr.
mass u f H-
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 V Windows/Doors _Pond
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq.Ft of Construction:: Sq.Ft.of First Floor:
Cost of Construction:$ D Z, • Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name fk\C f\ 5Z-IOSeI', Name:MLY-0 0 W(\ AR)o
Address: ygyq Nor+-h t�QhU)ram II1�W Company: \�lr y�ati�>�n (�>n1YC�ct�►�u ,%nc .
City: P\-�erCs_ State: T-L Address: 'P•(�• 1 y. \27�1
Zip Code: 3ygNq Fax: City: ffiyt P\eY(_4 State:F L-
Phone No. Zip Code:34gIq Fax:
E-Mail: Phone No ('_)12129-10k
Fill In fee simple Title Holder on next page(If different E-Mail�Y�C\k �Y�►�(7JC�t1011LDY�iYC�C�lr1(1. IY\
from the Owner listed above) State or County License CC-)C-
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.
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MENTAL CONSTRUCTION LIEN LAW INFORMATION:
ER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name:
: Address:
State: City: State:
Phone Zip: Phone:
PLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicable
Name:
: Address:
City:
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 Coun y and posted on the jobsite before the first inspection. if you intend to obtain financing, consult
with len r or an attorney before commencing work or recordi,rf your Notice of Commencement.
Sign ure o ner/Lessee/Co tractor as Agent for Owner Si ure o ntractor/License er
STATE OF LORD STATE OF FLORIQA
COUNTY OF 4 Lac i-o COUNTY OF _) I I_L,QCC,
Sworn to(or affirmed)and subscribed before me of Sw7 to(or affirmed)and subscribed before me of
_Physical Presence or Online Notarization ' Physical Presence or Online Notarization
this_day of 2020 by this_day of 2020 by
Name of person making statement. Name of person making statement.
Personally Known-AZ OR Produced Identification Personally Known V/ OR Produced Identification
Type of Identification Type of Identification
Produced Produced
7Sign�of Notary Publi a of (Signature of Notary Public-State a)
,�s 15iL�� 1�lct�ahor► ( g ry ��� Nicole
Cou 40054t��S onIIII.11GG35 7
Commission No. _ r; : � L� Commission No. +�
Exn,_ . ov,19,V poet:Nov.19,
Bonded Thm Aaron IN Bonded TW Aaron N0 ry
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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