HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
O
Building Permit Apliation
Planning and Development Services Building and Code Regulation Division Commercial Residential J/
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: �di4�T
PROPOSED IMPROVEMENT LOCATION:
Address: os
Property Tax ID #: - 1a/ Lot No. /!�L-
Site Plan Name: 42Block N,o
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - checl<all that apply:
`Mechanical Gas Tank _ Gas Pining _ Shutters Windows/Doors Pond
Electric Plumbing Sprinklers G- Roof
Genera -or _ Pitch
Total Sq. Ft of Construction: /2G _ Scl. Ft. of First Floor:
Cost of Construction: $ � per_ dg2 Utilities: Sewer Septic Building Height:
OWNER/LESSEE:
Name�Oae
Address:1429
City:ocii 110, Stater_
Zip Code: . Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if ;�-"f•; arent
from the Owner listed above)
'I ���ai4�Y6 C'-•^.sS �6
Narne:
Company: 001tR G
Address:_/�_pyt �37_
'in— Code:Fax: /V�1141-
E-VI`°BBi/J/►/
Ste e a
If value of construction is 2500 or more, a �CCOftE . ": `ce r� i s.rr�nc�,::�i:;
If value of HAVC is $7,500 or more, a RECORDED hiairn of COrnrrryIscernW r , rguired.
SUPPLEMENTAL C0NSTRUCT10N LiN:-i - _-,',1 _ e...... A'...
DESIGNER/ENGINEER: Not Applicable
Name:
Address: -y S
City: f _ State
zip: 3y _ gy Phone - 7�S-
FEE SIMPLE TITLE HOLDER: _L/Not Applicable
Name:
Address:
City:
Zip: Phone-,
J . PANY:
Address:
City:
- . Phone:
Not Applicable
State:
� � IiviLi COMPANY: NO( Applicable
name:
Andress:
City:
ip= Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby mace to obtain a permit to do the work and installation as indicated..
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable biome Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested pert -nit, i do hereLy agree that i ;vill, ;n all respects, perform the work-
in accordance with the approved plans, the Florida wilding Codes and St. _ucie COLnry Arnendmerts.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, si-rs, screer. rco€rs and accessory uses to another non-resident€aluse
WARNING TO OWNER: Your failure to Record a ,' ot`ce _' +Co,_tmenzeni8n_ -nay result ;,I$oardint; twi —, for
improvements to your property. A Notice of Commencement must be recorded Jr, the public records of St.
Lucie County and posted on the jobsite before the first irisoec`ion If �,ou intend to obtain financing, consult
with lender or an atto efore Commencing work or recording your Notice of Commencement.
j
Owner/ Lessee/Contr`actor as ,age 1i for ::^'.t'ne- S at_ rZ of C, r. roc r;'' ns
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STATE OF FLORIDA j 5"FA7E 07
COUNTY OF COUNTY 0F__/��q� -
Swo to (or affirmed) and subscribed before me of
Physical Presence ��or_� Online Notar:za-Jc5r,
this day of l—X.��� 2020 by
Name of person making statement.
Personally Known v OR Produced identifica.79cn
Type of Identification
Produced
ure of Notary Public- State of
S k.:)m to (or a`-=ir€ned) and subscribed before me of
', s`cc; ^ . s -, c� or Cni;ne Notarization
ay cf 2020 by
r1✓ _ L.
Game of person making statement.
ersanGi., OR :, a-- -ced ide:itika-don
iVpe of 16L.! ' i:.ca�,ion
Produced
(Signature of NO -Cary Public- Stacy of rlorida }
Commission No. ='�,RV°` uru rm GIn
.�: : COMMIS GG28522Q l�7iYii1ll55iOil :�•.
-4 E)tPIRES: December 18, 2022
REVIEWS
ZONING Sur xVlSur� I �i ;��S rm
COUNTER REVIEW REVIEW ) �:�§ 'EE'.' �',rIEW
DATE
RECEIVED
DATE
COMPLETED
DEONI3MPK
MY COMMISSION #t GG 285220
nds4 7bru Notary Pu011z Undenvrilers
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