HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO: MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED A I
Date: VAP2 7-02 Permit Number:
RECEIVED
O
Building Permit Application . OR.
Planning and Development Services Permittir artment
ucie GounrtY
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:G
.PROPOSED I'NIPRcOVEMENT LOCATI;ON..,, 1 7�..
Address: 1507 G GAS O—r 7�" TILE 3.
Property Tax ID #: 39 0a '66 % — 0 / o(S— 0 0 Lot No.
Site Plan Name:. I Block No.
Project Name: 10DiAJI5 RI\DC,(L CS"iii+t cs
. I
DETAILED DESCRIPTION OF -WORK: + '
.Ur`O�J I'Y1s-1-l�J L0.c'ct�� C_�
Xo`
New Electrical'Meter Second Electrical Meter
CONSTRUCTION":I N''FQRM'ATION:
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: C� f/ X Q Sq. Ft. of First Floor:
Cost of Construction: $ t-VID 0 0 Utilities: Sewer Septic Building Height:
OWNER/LESSEE; ' .
CONTRACTOR:
Name
(a
Name:
Address: O
Company:
City: U e.(� State: f 'L
Zip Code: �'9 9 ga Fax:
Phone No. OS r 5 tp3 — 0 to 7
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail
E-Mail: CS 0Lkta-1pJP keLW a6 •o U
Fill, in fee simple itle Holder on next page (if different
from the .Owner listed above)
State or County License
It value of construction is Z500 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.
r
SUPPLEMENTAL CONSTRUCTION LIEN LAWINFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name: 111M- 1 L`C-MrcRS— I Cvcaiuhc.a T5
MORTGAGE COMPANY: _ Not Applicable
Name:
Address,r'h,®, Elax wZ63 c1
city: %(X�i i35 State" 0 C
Address:
City: State:
Zip: 'L'`�CD(i Phone W- 6-lb — y26'L
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 issuarjce 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 osted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender att4rney before commencing work or1recording your Notice of Commencement.
Signatur�e4ofiOwn_ea Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORID I
STATE OF FLORIDA
COUNTY OF Lcic'
COUNTY OF
Swoto (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
✓✓ Physical Presence or Online Notarization
this _L_ day of ;026by ��
Physical Presence or Online Notarization
this day of 2020 by
r)'9
Na a of person makin statement.
Name of person making statement.
✓
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identificalt n `
Produced (� , f4r'ti C..
Type of Identification
Produced
(SignaturLyof Notary Pu c $tge.2 I da
(Signature of Notary Public- State of Florida )
. ZP?Y PUB'•.
o •.y UDR Y B. HUMPHREY
Commission No. i ? `�_ ti,y�WNSION#GG300817`
EXPIRES: March 6, 2023
Commission No. (Seal)
ZONING
REVIEWS
FRONT
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 0