HomeMy WebLinkAboutApplication 113All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
e L C tti tiv1,
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Residential 1�
PERMIT APPLICATION FOR: t�?
I PROPOSED IMPROVEMENT LOCATION: I
Address: 20L--2) S. Lvc:lc3
. `9\Va LC+ * 11
Property Tax ID #: t LA 2Ja- S-0' i - OOGI 2 - 0 0 0 - I Lot No. ), a
Site Plan Name: 9'0.Y-fC FAA, O Block No.
Project Name: Cti I S rJe F t r at
I DETAILED DESCRIPTION OF WORK: I
1-7
New Electrical Meter NIT Second Electrical Meter Kf [ (q (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply: N I H
Mechanical
Electric
_ Gas Tank
Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 2
_ Gas Piping
Sprinklers
_ Shutters —Windows/Doors _ Pond
_Generator _Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Nam op ( G
Name: 6Ittry `arr
Address:ZOZ,"� 34. Lc(c, el ud
company:6yK a veral
_
Ccrk-rar+cr4-fo9firaa lj,L
City:4-OC4- P( erGe, Statek- -
Zip Code: ,`�qq0-1 (c> Fax:
Phone No. Q, I S E'--H - 101 95
Address: (OQy (D UgA0\f, Sk.
City: G LGcA'-iOyaP
Zip Code: qff:Q
Phone No �; - LALa
State.
Fax:
- --7Cl
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail -A-Y-A r)A O
910 GMoA, • cc
State or County License Cr-,cBL4
�� 2D b
If 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.
Sworn t (or affirmed) nd subscribed bef �e me of
this 2 day of 1�_, 20j— by
Name of person making statement.
Personally Known "' 0j,2xad
Type of Identification Prod ced /
(Signatu
REVIEWS FRONT
COUNTER
901194
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
Not Applicable
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-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 vour Notice of Commencement.
Signs ure of Owner/ Less ontracto s Agent for Owner
STATE OF FLO I A
COUNTY OFm�X'-S ozke
V_�
Physical Presence or _ Online Notarization
w'%?y TIFFANY RENEE DENTON
Seal
( ) = _ MY COMMISSION#GG 243842
" EXPIRES: July 31, 2022
''lFlj�,';;°PoBonded Thou Notary Public Undorwdtel
ZONING SUPERVISOR I PLANS I VEGETATION
REVIEW REVIEW REVIEW REVIEW
SEATURTLE MANGROVE
REVIEW REVIEW