HomeMy WebLinkAboutBuilding Permit Application All APPLICA LE INFO MUST BE COMPLETED FOR-,APPLICATION TO BE ACCEPTED L�
Dater � Permit Number:a 1Ja. 1
21E. LLUCIIL RECEIVED
Co l ,
Permit
Building Pe Application
Planning and Development Services Permitting Department
5t,►„u 'e County
Building and Code Regulation Division `Commercial R2Sidenti8
2300 Virginia Avenue,Fort Pierce'FL 34982
Phone: (772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR:
.PROPOSED:IMPROVEMENT�LOCATION:
Address: Or Av C -
PropertyTaxID##: 321O nOZ03 Lot No.
Site'Plan Name`. Block No.
Project Name:
DETAILED DESCRIPTION.,QF WORK:
exiz� ,__ r_00P QAc4 [nS}atl AL ,n n �,.ia I R.S
t
M0 a , S1MU.-%
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 _WindowSJDoors _Pond
—Electric _Plumbing _Sprinklers _Generator .L Roof 10 Pitch
Total Sq.Ft of construction: Sq.Ft.of First Floor:
Cost of Construction:-$ /a 000 Utilities: _Sewer —Septic Building Height:
OWNER/LESS E CONTRACTOR
Name / rell Name: 'Q G' oneq
Address: —?Qg 4, LmCe ,�ompany:
City. r L�G'� 'State:�L Address:�1J1
Zip Code:3(4C/ %Y Fax: City:�Da.(-� �<-t. jwC,ie. State: L
Phone No. Zip Coder 34 9'8(1 Fax:
E-Mail: I LP— 3.10 OCKW Phone No — "- T7 70
Fill in fee simple Title Holder on next page(if different E-Mail C }ZCo . Qom&C G� C;(rC► .(iDy�
from the Owner listed above) State or County License ��'j(,3.�bls�S.�
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.BECORDED Notice of Commencement.Is required.
-
_ �P _&' }ter
DESIGNER ENGINEER: Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City:. State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: ____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-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 inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or record!n o Notice of Commencement.
e
S'ignaturdof-llw—n(r>40/CcXtractor as Agentfor Owner Signature of Contra 12;1Yce&XoIder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 54. ^ COUNTY OF u %_,
Sworn to(or affirmed)and subscribed be Sworn to(or affirmed)and subscribed before me of
Physical Presence or Online tariVion bt Physical Presence or Online Notarizatio
thisaa day of MCI l 20 l '4 z this QI day of M S
0 2020 by
oo
33 �
1_ Q .Y 1 N Q. Z
i Name of person making statement. cos o Name of person making stateme t. 3 3 0
»C� 33 _U
Personally Known ,l OR Produced I nttfi Personally Known :c OR Produced Identificatio
Type of identification - ° m =• Type of Identification
Produced ` ''"' p o N Produced cca
moo ayo
(Signature of Notary Public-Si5re of Florida ro o w (Signature of Notary Public-91te of Florida) p o-
toWCL
Commission No.�j Cg .27t/a4d (Se Commission No._6&COC1d 9 a (Seal) ^'C)w
REVIEWS FRONT ZONING j SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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