HomeMy WebLinkAboutcoppola permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
�n La ct'lf
r l_ o k i_ h `�, Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential YS
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: c :�i� C Vy _ oAr�r C_1�T'PU C�q �
Property Tax ID #: E q ?� 1 O Lot No.
Site Plan Name: .ems"Cjz- Block No.
Project Name:
DETAI/LE�D` DESCRIPTION
ESCRIPTIO 1N��OF WORK:
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:
Cost of Construction: $ >
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Namemr'r.&'l
NameeJF4-� l ✓ ��.
Address: !LN3 Pto C-Ay
Company: C-bK- 0- A S C'or
"
City: ` "J (" Stater
Zip Code: Fax:
Phone No.2 !y�0 rlgLy
Address�32_31
City: ,] �- State: PL
Zip Code:3Lt't-1 11 Fax:')7'Z ICe1 °Z6 O%
Phone No
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License ,. t c- Z w
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 I MORTGAGE COMPANY: _ of Applicable
Name:_
Address:
City:
Zip:
Phone
State:
FEE SIMPLE TITLE HOLDER: of Applicable
Name:
Address:
City:
Zip: Phone:
Name:_
Address:
City:
Zip:
Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 Horne 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.
C4
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF &{ ,c x,�
COUNTY OF Mkfi-i
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
`x Physical Prese ce or Online Notarization
w Physical Presence or Online Notarization
this /! day of 202 by
this day of �s 202 by
Name of person making statement.
Name of person making statement.
Personally Known P�-_ OR Produced Identification
Personally Known f2S,, OR Produced Identification
Type of Identification
Type of Identification
Prod Wced
Produced
(Signoture of Notary Public- Sta of Florida)
(Signat of Notaryublic- ate o Florida )
Commission No. Y., Seal) .IOSEPHBADINI
Coml ission No.
YA`"
MY COMMISSION # GG 2
14212 t :. JOSEPH MINI
:.. :�, MYCOMMISSIMiGG
Bone
ad Ttu Notuy Pubic Line�wrilera
IS
:y,F., . �.°-=D
PIRE& November 25,
REVIEWS
FRONT
VEGETATION
nd
COUNTER REVIEW
REVIEW
REVIEW
REVIEW
REVI
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20