HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ^^�� 1 j I f
Date: Permit Number: d, \ o 1 - �� IL(
P� W03 0
uilding Permit A lirmtion
pp do
Planning and Development Services � •0 B ��
Building and Code Regulation Division Commercial Residential ' •epa n yent
2300 Virginia Avenue, Fort Pierce FL 34987
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: `6 '/,�-& jLIL• ',,r'iv F6A'el Y f��rO
Property Tax I D #: ��O 2. - Cc 0 - d'23 00
Lot No. � C
Site Plan Name: Block No.
Prgject Name•
I nrTA 11 rr%'n-c-t-nln-ri^ 1 nr'%A!/nnw.
U 1MILL J' LJLJti..nIr I'rlJ14 Vr VVkJr\I\. '
New Electrical Meter Second Electrical Meter,
1 r1^K1FTn1 Ir`1rIr%h1 1i11rf%0hAA r;r%hl.
V t %Jlma1INV%_II,IV 11111-VIAMMII%J1Y. $
Additional work to be performed under this permit -check all that apply:
1/ .
-4mechanical Gas Tank _.Gas Piping _Shutters ) -Windows/Doors _ Pond
Electric Plumbing _ Sprinklers _ Generator ��- Roof Pitch
Total Sq. Ft of Construction: 1 1 Sq. Ft. of First Floor: _
Cost of Construction: $ Utilities: Sewer Septic
Building Height:
M
OWNER/LESSEE: .
CONTR^
Name 0x) . MQ �`3 �AR I M L
Name: - 1A-1 M
Address: 1 Q Tq t :�lQ
Company: Q Cu-%
City: �-oxV:o4Cc State:-
Address:
Zip Code: AL�� Fax:
City: �& 6Q.YcQ. State:.. -
Phone
Phone No. =1"L �21-'
Zip mode: 3Lr'$'z Fax:
6CNa e- 0A o vA
Phone No, -
Fill in fee simple Title Holder on next page ( if different
E-Mail 4VA , d% C.:c TY
from the Owner listed above)
State or County License (2(,C 1S L � 1. j
11 Vd1UW ul LUIISL(YLLIo11 Is L7uu or more, a KCLUKLOW NOTIce OT commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:—
DESIGN /ENGINEER: _ Not Applicable
a To,'r,n
MORTGAGE COMPANY: Not Applicable
Name: _ 2� .
Name: -
Address:
Address:
City: tate:
City: State:
Zip: Phone ('21
Zip Phone:
FEE SIMPLE TITLE HOLDER: X 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 snakes no representation that is granting apermit 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 ipnrlpr nr an attnrnpv hPfnra rnmmonrina %panrle nr rornrelina uno it i\in*ien of (-nrvrrnnrcmnr+
Signature of wner/ Lessee/Contractor as Agent for owner
Sign t re of Contractor/License Holder
STATE OF FLO
COUNTY OF_ � 1 "i
STATE OF FLOR!
COUNTY OF � :L I U
Savor rto (or affirmed) and subscribed before me of
Sw9/r to (or affirmed) and subscribed before me of
P ysical Pres nce or Online N tarization
this ' day of 3� by
Ph sical Pres nce or Online N arization
this day of . 202 by
pr
Name bf person makings atemefit.
Name of person makings tement.
making
Personally Known OR Produced Identification
Personally Known Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Sig Notary Publici- State of`Ftorida-)
-v. K 1 Rt�i 7�!.NE
No.
(Signature ublic- Statai
s1: rr�KA'"HAVEPiS
rnt5stoar,Commission
Commission No. s S ra G7 rrw. 6 a' �tJ.' Eau ., ? v eSO C 04.20
'W ; r 2)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 576120
All APPLICABLE INFO MUST BE.COMNCt'tED FOR AP ,LICAJO BE ACCEPTED
Date: Permit Number:
91r.
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:
PROPOSED IMPROVEMENT LOCATION
Address: 5322 `1�Fdrt YXc BOW 3 'M 4
Property Tax ID #: -��0C) - 02 G'\
Site Plan Name:
Prniart Name -
Lot No. l `ra
Block No. _ l
hr-rA 11 rm I1rr/`n1,nTP^i%i r%r' %Ar^nv. I
I VCIMILLLJ UL.3%_R F-IIV1V Ur- VVURN.
-�- X-k S
r, �raak Floc" 89 &LNe- 226 57, F
New Electrical Meter Second Electrical Meter
!1/1nICTDl1/`T1^K1 AATITA1. -
i' I.VIVJII\Vl.1.IVLV I1-V°rVl\1V1/_%IILJIV. I
Additional work to be performed under this permit -check all that apply:
'Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric Plumbing _ Sprinklers
Total Sq. Ft of Colistr i t o`no � -
Cost of Construction: $ `p 5 wo - oo
J
_ Generator
Sq. Ft. of First Floor:
Windows/Doors
Roof
_ Pond
Utilities: Sewer �CSeptic Building Height:
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name O1) CYQ %`3 vNQ_ M
Name: `(Q - �l e
Address:._ 22 �(1`�QJI►C �ci�IQ
City: �O�(� t��91C� State:-
Zip Code: Fax:
Phone No.' `-l2." Z, " i
E-Mail: 2 M'.. e.
"�
Company: An M iaA Ot`lS`RUC �0
Address:
City: �o`t Y��-Yc2 State: .
Zip Code: 3 LCiI 2, Fax:
Phone No. G0
E-Mail a:% o coTy
Fill in fee simp a Title Holder on next page ( if different
from the Owner listed above)
State or County License C 60- 152_� z S�
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:
DESIGN�,R/ENGIIVEER:
Name:
_
'00A TO nn •
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Address:
City:State:
Zip: Phone 663
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
Not Applicable
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 your Notice of Commencement.
re of
STATE OF FLO
COUNTY OF u( to
r as Agent for Owner
Sworrwto (or affirmed) and subscribed before me of
"'Plivsical Presence or Online N tarization
this day of 0 -2 by
Name bf person makings ateme t.
Personally Known OR Produced Identification
Type of Identification
ProducedLl___
Pu
Commission No.
nH I HEHINE HAVENS
MYCt�g1ON #GG165030
EX tEC 04, 2021
Bonded through 1st State Insurance
SignAtbre of Contra
STATE OF FLORIPAI l
COUNTY OF I
Sw r t to (or affirmed) and subscribed before me of
Ph sical Pres pce or. Online N arization
this day of 202�by
7 111�0lT��J_A�rdAn
Name of person makYOR
tement.
Personally Known Produced Identification
Type of Identification
(Sig
Commission No.
KATHERINE HAVENS
N gMISSION #GG165030
RES: DEC 04, 2021
Bonded through 1st State Insnran,.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
1
1
i
i
COMPLETED
Rev. 5/6/20