HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFOMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 0 1 1 l 2 III Z G Z 1 Permit Number:
4 ° Building Permit Application
Planning and Development Services \�
Building and Code Regulation Division Commercial Residential Yl y
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:' \CCOO
PROPOSED IMPROVEMENT LOCATION:
Address: U LV C \\ 1 L U
Property Tax ID #: FJ3SLJ ' C9()0 - r)OOC " LU C) ' d Lot No.. (9
Site Plan Name: V1f- 00iA-n "�yBlock No.
Project Name: htn'(1 -kAn \t'YLl
I DETAILED DESCRIPTION OF WORK: j
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
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ k 12 qrj7
_ Generator
Sq. Ft. of First Floor:
Windows/Doors — Pond
Roof Pitch
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name encn �.Vn
Name:1�C
Address: M20 SN Su I'D&)i n
Company:��,�s�'s I(lU Tk
=
City: `PCZC)c (5-t-. LuCie Stater
Zip Code: 3q9� (9 Fax:
Phone No. G -1 � ' LA-1� - LA7
E-Mail: L)Qcx*� r Q1 E \i �r V710 . C)P k _
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Address:-t)) !�5 M\K'
city :�O�% L U �� _ Stater
Zip Code: 5LI 6 9 Fax:
Phone No ZU?,
E-Mail
State or County License
If value of construction is 2500 or more, a KMUKUtU IYOilce vi t..ununcnwn1cu% q
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: ( Not Applicable
Name:_
Address:
City: _
Zip:
Phone
State
FEE SIMPLE TITLE HOLDER: A Not Applicable
Name:
Address:
Citv:
Zip: Phone:_
MORTGAGE COMPANY:
Name:
Address: _
Citv:
Zip: Phone:,
Not Applicable
State:
BONDING COMPANY: ! Not Applicable
Name:_
Address:
City:_
Zip: _
Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and instanation as inaicatea.
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
b f commencin work or recordin our Notice of Commencement.
with lender or attorne a ore92
Signature of Owner/ Lessee/Co ractor s Agent for Owner
Signature of (:ontractor/L' rise Hol r
STATE OF FLORIDA
STATE OF FLORtD
COUNTY 01:
COUNTYOF CIE _
Sworn to (or affirmed) and sub cribed before me of
Sworn to (or affirmed) and subscribed before me of
hysicai Presence or�_ Online Notarization
Physical Pmse ce or Online Notarization
this l� day of u� 2020 by
this Iday of 2020 by
1�Qm�A-e � 2q
Name of person making statement.
Name of person making statement.
Person y Known OR Produced Identification
Personal) riown OR Produced Identification
Type f Identification
Type o
ifcatioPro
ce
Produ
Q-e
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
�Q o,p,BYkPUQ ALYSSA A.T. BOWSE
=R @al) 2959
A.T. BOWSER
OCommission No.
Commission No. Commission t# GG
�� Expires January 28, 20
r r"ommiss'i0n # GG 295930
3 '' h Expires January 28, 2023
04
r.
„' ,�;-2ondedl ru8utlgelNotery em
REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/ b/ 1U