HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ii,,,
Date: Permit Number:. o—'�� (y \t)a
2117.LLUCDL -
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division COClliflefC.121 Residential k
2300.Virginia Avenue;Fort PierceTL 34982
Phone: (772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR:
MOP IMPR`OVEMENT�LOCATION .
Address: SQOq 01e0 i 1%ts. CA.
Property Tax ID;#.: )31 a $OI- 00 aa- 000 - I Lot No?�o
Site Plan Name: Block No. a` q L
Project Name:
DETAILED DESCRIPTION QF 1NORK
AA csa c
New Electrical Meter Second Electrical Meter
CONSTRUCT N INFORMATION
Additional work to be performed under this permit=check all that apply:
_Mechanical _Gas Tank —Gas Piping r Shutters Windows/Doors _Pond
_Electric —Plumbing _ Sprinklers Generator V Roof Sala Pitch
Total Sq.Ft of.Construction: 6y50 Sq. Ft.of First Floor
Cost of Construction: iSO o Utilities: _Sewer _Septic Building Height:
OWNER/LESS ONTRAC
EE CTOR i
Name X1 o h A/rl t'+iad Ada a. Name: r� UI1 rd
Address: 3YD6 ouna-G Way Company: Tr.t A3rJ/4_ Gas{ peau�i��l
r t1
City: I'O r r'�i t c�tit, State:FL Address: 181 b �__ i 1 mr"-k S�.
Zip.:Code: 3gg a& Fax: City:_�L of t• s� • Lo Gee, state:ri, .
Phone'No. 171- t:n - e
, 3 �� Zip Code: AL15 A Fax:
D
E-Mail: Phone No ? s.-310 yi-t o
Fill in fee simple Title Holder on next page(if different E-Mail —ro- lZ sA 4 IVa L L C, Ma;4•cn M,
from the Owner listed above) State or County License C C C 1'�3 a 6S 3
If value of construction is 2500 or more,a RECORDED Notice of.Commencement is required.
If value of HAVC Is$7,50D or more;a,RECORDED Noticeof Commencement is required.
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DESIGNER ENGINEER: _Not Applicable MORTGAGE COMPANY: ` Not Applicable
Name: ` Name:
Address: Address:
City: State: City:. State:
Zip: Phone 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-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 commencinwork or recording our Notice of Commencement.
Signature of Owner/bgsWcontractor as Ag 0 Signature of Co r or rise Holder
STATE OF FLORIDA < STATE OF FLORIDA
COUNTY OF .S'4 o� n o COUNTY OF S� v
� z oo�
Sworn to(or affirmed)and subscribed before eJf3. < Sworn to(or affirmed)and subscribed before m of3 3
X Physical Presence or Online Nota a14.Q o K Physical Presence or Online Notariz i 3.-o
this Jf day of iTy4 2020 b > > o this �� day of �?'vru 2020 by o•v o
/ pZ X D > > n
rl'2.. a�n �''w m /' ' a/aq c X rn�
i Name of person making statement. N 1— o• Name of person making statement, (D CD m
�I�-n m' o N.
Personally Known ce OR Produced Iden 1C 1 Y1:• Personally Known -C OR Produced Identifi tiN�f7�-n Cr
Type of identification OW Type of Identification ro .
Produced N Produced ^' 1.w
N
!IA�
(Signature of Notary Public-State or-Florida} (Signature of Notary Public-Staferof Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING j SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
lev.5/15/20