HomeMy WebLinkAboutbellows permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `7 "`% '-Z-I Permit Number:
CQUN L)'
f L o) i`- L L, tz Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginio Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: �3 2- � Mai u),_4
Property Tax I D #: 3 ,3 2-7
Site Plan Name: Z>at10G__
Project Name:
r
ADZ_ 00007 -00 0 -- !
u
S
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
ev re-P1 _ - �nf �, � var,, S�rZ� r Sa`z 6,6 ` 7 T
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: Sq. Ft. of First Floor:
Cost of Construction: $ 6? ?l% 06-, Utilities: —Sewer —Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
J
Name t c .� 3 Ems! /a w_5
:�
Name: r4tj — vo 0
Address: '_Z , �S hr
Company:c—ov- Zv'[_ %gyp
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City: ( 120"besL-r-J State: P-
Zip Code: 0 2 %Y Fax:
Phone No. VO i ,3,r
Address:3730 5E
City: _ Stv_ C► r >ti_ State:FL
Zip Code: ?7 Ll I Z'7 Fax:
Phone No 17 t- �1 '� I Z D5—
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mailer -P-' a CJ t' /L" I e,
State or County License 6-6-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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: =Zpt Applicable
MORTGAGE COMPANY: of Applicable
Name:
_
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: Not Applicable
94
BONDING COMPANY: of 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 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 our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signaturentractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF &jE_rt-/,
COUNTY OF P S� --`✓n
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
17h ical Presence or Online Notarization
-Physical Presence or Online Notarization
this day of _JY)�, , 202+ by
this l day of _ �'t r,��� 2021 by
Name of person making statement.
Name of person making statement.
Personally Known Z�_T OR Produced Identification
Personally Known P�,,_ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
LOP,
PH
J
(Sign ' ure of ota :� d_ FI�I ISStON GG 274212
of Notary Pu F IS51ON # GG 274212
`EXPIi2E;a: November 25,2022�o�
Commission No. PdR*t�:� PUMP S1 6rfAEyPublicUndemiletsmission
rimgnatufe
EXP 8' 25 2022
No. ?-• ��Public Ik�eExRite:s
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.