HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE CCAvir- .ETED FOR APPLICATION TO BE ACCEPTEC -`
Date: �.• ��' oJ1 J Permit Number:
0 Uo L�I�IRECEIVED
O
p . Building Permit Application DEC 17-2020
Planning and Development Services Permitting Department
Building and Code Regulation Division Commercial Residential
St, Lucie County
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: 100 IV. INQUK NQ
Property Tax ID #: _ 2 u. n • no �loL'_ Lot No.
Site Plan Name: _ Block No.
Project Name: -es rr STo/Z4 - j"/I fsonJ 9;911DGR
New Electrical Meter Second Electrical Meter
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 Construction: '7, -a e0
Cost of Construction: $ Y 9;5; 1 15-0. 00
Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Utilities: —Sewer _Septic
Name` S - L A+ -
Address: auo ►—�!i�t e-
City': i i o` of eL State: �l
Zip Code: `; �Agtq'- Fax:
Phone No. 7 7,2- 416 4 — 19101
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Roof, Pitch
Building Height:
�lrn4 e) S Inc .
Name roie�_l'onfr,,�
�'
Company:_ Pfdtd
Address: a
City: �. °21e-� State:
Zip Code:: �{ �6~� .Fax:
Phone NoP
E-Mail k' hcS r
State or ounty License e4e-�-a 7/S-1
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If value of construction is 2500 or more, a KtGUKUtU Nonce or UUrnmcn C111=11a 1=y...•
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
Name: Qene-krn,2:sl� �n�in�eF��
Not Applicable
o• 1'
MORTGAGE C PANY: — Not Applicable
game: A
Address: 1506 el
Ave., c�`as►
Address:
City: State:
Zip: Phone:
City: ['fee— State L
Zip: sajeo Phone
FEE SIMPLE TI LE HOLDER:
Name:
_ Not Applicable
BONDING COrPANY: _ Not Applicable
Name: /lJ 4
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 indicate❑.
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; l 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 i'n the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
b f mmencin work or recordingour Notice of Commencement.
with lender or an attorne a ore co
V��e /4/-,
gizz. .-
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Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor icense Hol er
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF I%.Ji
Sv�i to (or affirmed) and subscribed before me of
Swo,�i to (or affirmed) and subscribed before me of
_ �Ph!�sical Pres a or Online Notarization
/ by
d Ph sical Pres ce or Online Notarization
this � day of 2020 by
this 1_[_ day of 2020
7;16'�Z
Name of person making statement.
Name of person making/statement.
v
Personally Known OR Produced Identification
Personally Known OR Produce Identification
Type of Identifica 'on
Type of Identification
Produced
Produced
(Sign ture of N
(Signature of t r Pu ic- State of rida)
SPpy pV�� KAREN S. NIELSEN
,.�;YP�e, KAREN S. N�EN
Commission a° -a
Commission No.
��° ��;State of Florida y Public
_ _ t qq
ission #207484
_ lorida-N tar Public
_* *E, Commission # GG 207484
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