HomeMy WebLinkAboutapplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation DlvUlon Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone. (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: a lr7� • c
Property Tax ID #1 Lot No.
Site Plan Name: R M ) a R o Block No.
Project Name:
I DETAILED DESCRIPTION OF WORK: I _ I
in
New Electrical Meter Second Electrical Meter ---
CONSTRUCTION INFORMATION:
Add itional'work to be performed under this permit —check all that apply:
—Mechanical — Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ f D
OWN ERAESSEE:
Generator
Sq. Ft. of First Floor:
2
Windows/Doors _ Pond
Roof Pitch
Utilities: —Sewer _Septic Building Height:
Address: 3Z/40 Sc/- r, c= gztl d
City: r - e State:
Zip Code: 3 Fax:
Phone No. 772 3 3
E-Mall:8AQ �% /.GOB
Fill in fee simple Title Holder on next page ( If different
from the"Owner listed above)
CONTRACTOR:
Name; Tom Saurey
Company: Tuff Shad. Inc.
Address:1777 S. Harrison St, Suite 600
City: Denver State: CO
Zip Code: 80210 Fax: 303-474-5526
Phone No '► -a § a
E-Mail li
State or County License CBC1253645
If value of construction Is 25W or more, a RECORDED Notice of Commencement Is required.
If value of HAVC Is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: •
DESIGNE ENGINEER: _ Not Applicable
MORTGAGE C NY: Not Applicable
Name: +uch-dwils
Name:
Address: 177? s Hamwn simet, sums sm
Address:
City: o«,rar State: co
City: State:
Zip: W210 Phone 303-414•5524
Zip: Phone:
FEE SIMPLE TITLE HOLDER: ` Not Applicable
BONDING COMPANY: Not Applicable
Name
Name -
Address:
'�
Address;
City:
City:
Zip: Phone:
Zip: Phone;
Uwnll`R/ LUIVTRACTOR AFFIDVIT: Application Is hereby made to obtain a permit to do the work and Installation as indicated.
I certify that no work or installation has commenced prior to the Issuance of a permit.
St. Lucie County makes no representation that Is granting a permit will authorize the It holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws gr an$c=nants that may restrict or prohibit such
structure. Please consult wit your Home Owners Association and review your deed or 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-residentlal 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 inspectilo{�. If you Intend to obtain financing, consult
with lender or an attorney before commencine work or recardink your Notice of Commencement_
Signature of Ow r/ Lessee/ ntractor as Agent for owner
Signat re oVon�tffir�actorZ/L&Rle-older
STATE OF FLORID
STATE OF COLORADO
COUNTY OF
COUNTY OF Den-
5 rn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence r Online Notarization
t Is day of 202�1 byM�l
x cal Presence or Online Notarization
May
this of 12020 by
A&L-6 (-fa-610' I
Tom Saucy
Name of person making statement.
� zCO
Name of person making statement.
Personally Known OR Produced Identifi
ti
Personally Known x OR Produced Identification
ri
Type of Identification
Produced t
2
Type of Identification
Produced NIA
o
01
z�
w
k4
A
(Signature o0lotary Public- State of Florida)
Ignature of Diary public- State of Colorado }
Commission No c_ (Seal)
��AVJ
ommission No. (Seal)
P "
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MA
N
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
W41
DATE
RECEIVED
DATE
-T-
COMPLETED
ev. 5/15/20