HomeMy WebLinkAboutBuilding Permit ApplicationAIL -APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED o Fo
Date: q - f " 1 � Permit Number: � �✓
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° Building Permit Application
Planning and Development Services
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: - (. ah��
Address: q 5,S^O
S v c'tr -z;�t 0`14W
Property Tax ID #: LiVb 12- 16o0 ( - 01 rY - 00 �,2 Lot No.
Site Plan Name: Block No.
Project Name:
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit- check all that apply:
_Mechanical
_Electric
Gas Tank
Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ .32176,0 C;r.'
_Gas Piping
_ Sprinklers
Shutters
_ Generator
YWindows/Doors _ Pond
Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LE�SSE
• N RA R:
Name
Name: M jc,"V2
C.94WW,
Address: q0O S- ()6t7rw )& /4/0
Company: /u 1-0 CpM-7'LA-C1701!T
Address: 1 `lam 1;6
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6aA-0daiqy-t� 4J6"
City: -J-ays Ii /?eftc.` State: JrL
Zip Code:,?c/CIf7 Fax:
City:
State: Ill -
Phone No.(8l S) ' 19 - 7Za3
Zip Code: Fax:
E-Mail: eAyL, C.UM
Phone No 7 %2
OJ7jD
Fill in fee simple Title Holder on next page ( if different
E-Mail A(c6 41- c-
(? PS61-?�1V/L4A11WC0-,
from the Owner listed above)
State or County License
C CSC 1 �_Z? KSG
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.
�SIJPPLEMENiAC*ONSI'RUC I • LI LAW 1NFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: rW✓U134 Ag uru+N, k-N& gNri
_
Name:
Address: 5.bi PiyO
Address:
City: i2qw/k State: ram-
City: State:
Zip: Phone Jc l 371-o2yo 3
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, fe ; ces, walls, signs, screen rooms and accessory uses to other non-residential use
WARNING TO OWNER: Yo f I e to Record a Notice of Commencement may re t in paying twice for
improvemen ou pr p y. A Notice of Commencement t b re ded in the public records of St.
Lucie Count an os a jobsite before the first inspec : n If o tend to obtain financing, consult
with lend or r y fore commencing; work or reco In v tice of Commencement.
Signature o \Ow er/ Less ontractor as Agent for Owner _
`Signs ure of Contractor/L ec n Holder
STATE OF FL RID . 'A
COUNTY OF!!1-
STATE OF FLORIDA I
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COUNTY OF
S o to (or affirmed) and subscribed before me of
WF hysical Pres c or Online Notarization
S orn to (or affirmed) and subscribed before me of
hysical Prese e r Online Notarization
this day of 2020 by
Is 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
I�Au
Produced
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(Signature of Notary Public- State of Florida) Taylor ien
(Signature of Notary Public- State of Florida )
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Commission No. " ` eQ . OF FLO
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I6pmmission No. u Q� TARY
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