HomeMy WebLinkAboutBuilding Permit Application-ORIGINAL All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -z u 1�L( Permit Number: '0 o""D
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,�" 0.-•_.__` :_D.::L•" 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 IM'PROVEM'ENT LOCATION:
Address: )317 CO PC4 L(A✓CL AD.
Property Tax ID#: 2313 "214'6b03'6ob "5 Lot No.
Site Plan Name: 1 31-1 CO pEX)q V 5/L QD. Block No.
Project Name:S5t - LW AI,, (COOL
DETAILED DESCRIPTION OF WORK:
N L 60A)STAIACT1061 W PA I-JUL DCrJC-
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:$ q0.000 Utilities: _Sewer ✓Septic Building Height:
OWNER/LESSEE: CONTRACTOR: -
Name LRftLoTTE STAdI ZERC% Name: Cµ 113TAL- WAS0 314W
Address:Ian C ftwuf0 EIL P-D • Company:A'M012 LS I C .
City: FT - �E(LLE State:P— Address:8 3710 lq" a.
Zip Code:34IgS Fax: City: khFRO &kC* State:
Phone No. Zip Code: 32 &7 Fax:
E-Mail: Phone No —7c5
Fill in fee simple Title Holder on next page(.if different E-Mail
from the Owner listed above) State or County License lmn?--S �to to
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: _Not Applicable MORTGAGE COMPANY: k—Not Applicable
Name: g7 L•-S 1 D �nJG►I N fit.. Name:
Address: I31j SI,11w-E 10" Address:
City:Q^�I.n 69-f;F Gort E&& State: L City: State:
Zip: 33N Lg Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: `-Plot 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 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 attornev before commencing work or recordi our Notice of Commencement.
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Signat Ow er Lessee/ ractor as Agent for Owner Si ture of ntractor/License Holder
STATE OF
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OF FLORIDA
O ORUNTYOF �u�v COUTNTYOF St Wz4`t
Sword to(or affirmed)and subscribed before me of Sv�glyf(to(or affirmed)and subscribed before me of
Physical Prese ce or Online Notarization Dlr� Physical Presence or Online Notarization
this 1,6 day of r� t- 2020 by this f�day of t 20211 by
urly c 4t"lb r �!-�.( wash
Name of person making statement. Name of person making statement.
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Personally Known OR Produced identification✓/ Personally Known OR Produced Identification
Type of I ntiftcation Type of 1 nti(ication
Produced(y JCS -c.n${ Produced ir c/
4 y pie,, ALEU KRATT lorid
(Si ature of Notary Public- $ bri mission#GG 984139 Signa ur of NotaryPublic-S ` i
d _M Comm.Expires May 4,202 " , nary Public-State 8 139. a
•••:,, of�.r y � �� Commission A G 98 139
h National NotanJAss G 4
Commission No. Bond 13oFF` Expires May 4,70 4
mmission No.
BondeE�t rough National Notary'As in
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.5/6/20