HomeMy WebLinkAboutBuilding Permit Applicationv;/t�A
All APPLICABLE INFO MUST BE COMPLE rw FOR APPUcAnbN TO BE ACCEPTED -1
Date: - 1 Permit Number:
21r. [LUC1�'��a' RECEIVED
. o
Building Permit Application
JAN 19 2021
Planning and Development Services Permitting' /Department
Building and Code Regulation Division Commercial R Sid tpltig ' �i FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
'PRO.POS`ED'I'MPROVEM'ENT LOCATfON:
Address: 5-3 13 5 3f, P41H PIeI_.6 EC., 3 yg.5;- r
Property Tax ID #: l gc;r'g141-&00A,-C200 -- ( Lot No.
Site Plan Name: Block No.
Project Name: Thd M 4R6 8 eS.
DETAILED DESCRIPTION O'F WO.RK:
c.onS`LK.f/0 /► D -1&' ar ji eta fe.- `ele2 era t- _kym e . 1 56711&o40 .
New Electrical Meter ,!_ Second Electrical Meter
CO'NSTRWCTION INFORIVIATI`ON'.
Additional work to be performed under this permit- check all that apply:
)Mechanical —Gas Tank . —Gas Piping _ Shutters
XElectric Plumbing _Sprinklers _Generator
Windows/Doors _ Pond
Z Roof CA 2- Pitch
Total Sq. Ft of Construction: %5� Sr. FT- Sq. Ft. of First Floor: 25^7 / 5 , 17
Cost of Construction: $',3Z.upoo oy--- Utilities: _Sewer ZSeptic Building Height:
OWNER%LES_ §EE
'CONTRACTOR: '
Name 549-- n onet 5aa h TAoqi a
Name: M k- a)
Address: IZT'O 5ed FAhrX,,7c4 A Ve
Company: cv -F 5 `-e
City: C ,-_ State: f
Zip Code: -Iy3-,5 Fax: {1/
Phone No. W#
Address: 5
City: Pori¢ 'ff Lk-n; e State: L�
Zip Code: /1C/ lvq Fax:
Phone No XZL-42_6- �/ 76
E-Mail: 84
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail�� !n� g iI7Ged-C-0A
State or County License C c 12630 i 2
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.
'SU'PPLEMENTAL C'ONSTRUCTI,ON LIEN LAW INFORMATION:
DESIG R/ENGINEER:
Name:
Address:
of A plicable V
1
MORTGAGE COMPANY: �Alot Applicable
Name:
Address:
Ci
Zip:?,LBT-L Phone-1-1 '3—
State:
5'L 1-5-4
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
Name:
of Applicable
BONDING COMPANY: _Not Applicable
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 job ite before the first inspection. If you intend to obtain fp�' lancing, consult
uii+h Innr4or nr an/ttnraPv hafnr.�rnmmpnring wnrk or recordine voLlr�iClotiae of ComR7�f'cement.
Signature Owner/ Less /Contractor as Agent for Owner
Signature o ontractor/Licens older
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 5T Wq e
COUNTY OF `:Tr d- s3o C
Sw`9rn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
1L Physical Presence or Online Notarization
� Physical Presence or Online Notarization
this � day of 2020 by
this 1c�k day of L—_Yp,14 2020 by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known_ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
A
wL
oft
(Signs of Notary Public- orl I'yPublic Stateo1Flp1da
( ignature of Noi=99EE
icStstsofFlorida
Robin L Bowen
Commission No. �'� 9�a A ( ES otipgn023 2eez12
C mmission No.
owen
sion G3 298212042023
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
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REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20