HomeMy WebLinkAboutAll APPLICABLE INFO MUST BE COMPLETEDAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date_ l I—/ Z ` Z
Permit Number.
Building Permit Application
Planning and Developmen t Services
—[-Ing and Code Regulation Division Commercial
2300 Virginia Avenue, Fort pierce FL 34982
Phone. (772) 462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: T120 • A e
Property Tax ID # -T/,2- O / - Q 3- O,
Site Plan Name:
Project Name.,
DETAILED DESCRIPTION OF WORK:
C,''--c/P
Residential X
r y olc-c
o r h/4cG/<-„ /" k J�'
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
Electric ` Plumbing — Sprinklers __.. Generator Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction: $ 0 Utilities: —Sewer _Septic
Lot No..0
Block No -
Building Height:
Pond
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name '�q lan fG,,-,,,'IeX
Name: � .1 yoc(
r611-1ir
Address: r2oZ 41e, P! C,/
Company: C4' .-
F:°--, c„
City: �><, "v State: �/
Zip Code: �t/%, Fax:
Phone No. -77 2 E 761'
E-Mail: //I%��Ge C-K5e '
Address:l�/ r 4,, j
City: - P/C C State: C7/
Zip Code:/ Fax:
Phone No 77Z
Fill in fee simple Trtle Holder on next page ( if different
from the Owner listed above)
E-Mail A&/.0, {e"'- �o
,_'.• c C4� ��.c. • / j Geri
State or County License
d"
IT value of construction is ZbW 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: _ No Applicable MORTGAGE COMPANY: Not pplicable
Name: —
Name:
Address: Address:
City: State: City: Stater
Zip: one Zip: Phone:
FEE SIMPLE TITLE HOLDER: -- Not 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 attorney before commencing work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for owner
Signature of Contractor/License Holder
STATE OF FLORIDAr
- LJ-t-C
STATE OF FLORII?A r
COUNTY OF L`2
COUNTY OF
Sw9tn to (or affirmed) and subscribed before me of
Sw,f to (or affinned) and subscribed before me of
✓
ce o
Physical Pr r Online Notarization
PF�ysical Presence or Online Notarization
this Ia day of 2021 by
this L day of CL f 202* by
Name of person making statement.
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification t�
Type of Identification.Type
of Iden ' cation
Produced �C7 (,I ��
Produced 0 t'td(l`b l(
Q '
c��A/ r l � " �J�sL•��l
(Signature of Nota
(Sign - TaM 61 M da )
S JSxr A. gpwEH
'
h�sdry D��'�i of Florida
Commission No. = " = `�5
4otar.=,.a,i_ R3:e -
Cam issiart �. " (Seal)
y�� ommisso 326633
'�" •.- w, Comm. Ez7�rp5 Ju! 2L. 2Q27
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FRONT
ZONING
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DATE
COMPLETED