HomeMy WebLinkAboutPermit Application 2106-0750All APPLICA /
B'_ INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED , r�
Date: & f Z_ce-a-1 Permit Number: 0 -75 0
LUC1L
P L (-) l� L c `' u_- Building Permit Application
Planning and Development Services
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: -1. n L_� �6n
PROPOSED IMPROVEMENT LOCATION:
Address: �� ��� �C.._ 1�1.
Property Tax ID #: a U'— 7
Lot No.
Site Plan Name: rr �`` -- Block No.
Project Name: 1...- +6 n C_e 4; 6 Qn—'e—es,
DETAILED DESCRIPTION OF WORK:
lau L"Uc't'-�zr k(_).CL' 1�� - �A+ -'� e -_
_C't P _� - <; C e I-e-
+r
4-0 sir V '/_z esee o,-4rzL(v.,d spee_s)
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 Windows/Doors Pond
Electric Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
c�v
Cost of Construction: $ Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
Name - 50 1 TTz %l
Address: L--i ve-, '1 -
City: E -�' i rC_ State:
Zip Code:7� Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name:_ Inei n LoLx c_M-S
Company: f0mte"`
Address: I `��? ► l �t.`
City: �-r'��-C? 4tC �n State:L
Zip Code: f L,& Fax: 7�-' `►� ���53-
Phone No+
E-Mail 6f rj /` C£,•'�'
State or County License
If value of construction is 2500 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 CONSTRUCTION LIEN LAW INFORMATION:
DESIGNI
Name:_
Address:
City:
Zip:
NGINEER: Not Applicable
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:_
State
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone: -
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
Not Applicable
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 attnrnpv hpfnrP rnmmpnrina wnrk nr rarnrrlina vni it Kintirrc of ('nmmonroman+
Signature of Owner/ lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA.
COUNTY OF �)�.,'1 y�
STATE OF FLORIDA
COUNTY OFn��
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
L physical Presence or Online Notarization
this day of Ti t,rl 2020 by
Physical Presence or Online Notarization
this day j 202p by
_
of s 01,L&-
Name of person making statement.
Name of person making statement.
Personally Known ; OR Produced Identification
Personally Known I\ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
.b
(Signature of Notary u, �P ,tate o
� - M BRIi)GER
Si n
( g at�r of Notary P is � e o
_ - Notary Public - State of Florida
Commission No. a= o` C mmi deal HH 115773
(;
'�-„ Ue�e. G NIA M BRIDGER
= r NotaryP�uub��lic - State of Florida
Commission No. =�
oF� ,.• My Comm, Expires Jul 17,'2025
Comrfrat7�� HH 115773
vFfl° My Comm. Expires Jul 17, 2025
Bonded through National Notary Assn.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
MANGROVE
SEA TURTLE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.5/6/20