HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Permit Number:
RECEIVED
COUNTY
' A Building Permit Application APR ® 5 1011
Planningment
and Development Services Permitting D�� tY
P St. Lucie W ourtty
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: ��� }`�•
PROP.OSfD IMPROVEMENT LOCATION:
Address: 5* 0 _S :&A9ticvn ilern Ln
Property Tax ID#: 13 ) 0�- S00 -GQ- 2'Vo� r � Lot No.
Site Plan Name:���wwl 4kirew, Block No.
Project Name: 0 Ir PrA vi
DETAILED DESCRIPTIO41-10F WORK:
C--A,1- ca- ?o b.' /Y S 1,.,6 //J rc u.H A- •1:.r.- 1�y /Lc. let.c l7/ f1 1-
Vl..� 6.10111 !� Y Y�,I Je- r,.�d,4 !2" �.. /Z11
Fob S .2- 1 Y A b..r 3600 In rsr Fd-�. SffriGfG-�.
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: 1(S Sq. Ft. of First Floor:
Cost of Construction: $ 2-`l S D Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Gl�.��s LtMa�cJ�U Name: ��,I c4 d.►•��
Address: .6e" cl Company:UTC_. Ce--cs-44-C-- I9l,,S LLG
City: �"l /dui State:��' Addresps: ,F?,%0 GG.r•� Ca...w( X8—
Zip Code: 311 5 1 Fax: City: POI' 54 State:Fl
Phone No.54/ &O S/ 7? Zip Code: 3 0 $7 Fax:
E-Mail: Phone No ?7 2— Zrto - 13 y&
Fill in fee simple Title Holder on next page(if different E-Mail OTC,. Co"L4444,. Ill v S ® o.v/. c.a N•
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.
s
SUPPLEMENTAL CONSTR�;U,CT10NtLIEN LAW INFORMATION
�F
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
improvements to your property. A Notice of Commencement mu�TtDbj recorded in the public records of St.
Lucie County nd d on the jobsite before the first inspectionu in d to obtain financing, consult
with lender r a attor a before commencin work or recordinur N&ico of Commencement.
Signat�11
O Lessee/Contractor as Agent for Owner SigVN
of Contractor/License Holder
STATLORIDA STF FLORIDA
COUNTY OF ln�,Q Q . C OF �o
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
--+ Physical Presence or Online Notarization Physical Presence or Online Notarization
this- —day of 'Mta, g k , .2020 by this_Q__day of ( ,2020 by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced �_ Produced Q�1
natu a of Notary Public- M.ate of Floridag � (Signat ►e oPTV�taryj , ..K
Ye�y' LASHAHNAINGRAM-PWIMING _,. MY COMMISSION it GG 2750
Commission No. MMISS!(SPS�r� 275060 Commis o :,2 r xnr�Fs flarnmber20,202ge )
o` EXPIRES:December 20,2022 Bonded Thru Notary Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20