HomeMy WebLinkAboutSocarates Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (10 I 10 I Z dZ 1 Permit Number:
° Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential ,Y X �C
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: E /
), n1CC�t
PROPOSED IMPROVEMENT LOCATION:
Address: -1 '59 2 r-Vyr)e Creel% WW.
Property Tax ID #: 332 2 - 2133 - 00-�o - WO - 3 Lot No.
Site Plan Name: 73�C`<' goo Block No.
Project Name: tocrCles 2c�cr\o j
DETAILED DESCRIPTION OF WORK: I
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 14 Shutters _ Windows/Doors T Pond
_ Electric _ Plumbing _ Sprinklers — Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ A i oas Utilities: —Sewer —Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name
Name:
Address:,-13y2 CYtte NCk"
Company: CJcc-?V 17-hker �
City: (} L-Ucke, State:
Zip Code: L;�A cl &-9 Fax:
Phone No.-- 1-12 - 2 0.1 - qq iq
o,
Address rN!5 N� !Q�� e '-Orr
City: rr's c�C�l LU l`e Stater
Zip Code: _ Fax.
� Phone No Z- 2q I Q
E-Mail U�� ShU��sE;',r i� Q GSVbaiccVY�
E-Mail: cJ5 � e CO
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License
IT value oT construction Is L!)UU 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 CONSTRUC ION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: V Not Applicable
Name:
Address:
City: State:
Zip: Phone
MORTGAGE COMPANY: of Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
BONDING COMPANY: Not Applicable
Name:
Address:
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 r corded in the public records of St.
Lucie County a posted on the jobsite before the first inspection. If intend to obtain financing, consult
with lender 9 e n attorney before commencing work or recording V. r Notice of Commencement.
S ure of O ner/ Lesse ntract as Agent for Owner
WnTature of Contractor/L' ens older
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF S-{- I C.."C I C
COUNTY OF ' fi wCl
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
�hysical Presence or Online Notarization
this IU day of Jy 2020 by
this (0_ day of 2021 by
2 202
S(A wr U-P_ I ZQ 2�
Name o person m statement.
Name of person making statement.
Perso y Knowp�_ O Produced Identification
Per nally Known �"�� Produced Identification
Typ of entification
Ty e f Identification
Pro u
P o ce
(Signature of Notary Public- State of Florida )
(Signature of Notary Public- State of Florida)
zv F�" ALYSSA A.T. BOWSE
Commission No.� aasR�eal)
"v nU' _ A A.T. DOWSER
Commission No. (�S (�
Comrrussion # GG 2959
Expires January
0 1r. t s Commission # GG 295930
o 28, 202:^"
Expires Janua
n e uBudget Notary serices
For•Fto Bonded
hruBudget Notary services
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DATE
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DATE
COMPLETED
Rev. 5