HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPETED FOR APPLICATION TO BE ACCEPTED
Date: M \ 11 \ 9'\ Permit Number:
RECEIVED
° Building Permit Application MAY 0 7 2011
rmitdng Dspartment
Planning and Development Services FgSt. Lucie o, my
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: 2(=5 1-b GT,1 4_�),MG
PROPOSED (IMPROVEM(NT LOCATION Fri„ yet 4
Address: Q763 13-3!:�_b1a I,)A;'
Property Tax ID #: ?. It — 781 ` cao Z 1 _ 00c> > Z Lot No. 1_
Site Plan Name: t o eY Block No.
Project Name: CAA Z tTa(J C_C)U'7rf- '
New Electrical Meter X Second Electrical Meter
Additional work to be performed under this permit —check all that apply:
>G Mechanical _ Gas Tank —Gas Piping _ Shutters Windows/Doors _ Pond
X Electric x Plumbing _ Sprinklers _ Generator _ Roof / Pitch
Total Sq. Ft of Construction: �zao Sq. Ft. of First Floor: I&Y-)
Cost of Construction: $ �Oco Utilities: _ Sewer X Septic Building Height: 19"�'—
OWNER/LESSEE x
CONTRAC7"OR
Name
Address: Z?e3 SC- _�Jut-r'\ WI-c-,
City: �U� 6r1: �_6c:a State:
Name:
Company:'RDA ow G,v " U
Address: Z30S-ek0&. etAdw��c��C
City: State:
Zip Code: 3491 Z Fax:
Phone No.
Zip Code: 734c(g Fax:
E-Mail:
Phone No -7%7' Zi6 —N 186
Fill in fee simple Title Holder on next page ( if different
E-Mail RFRwN o m► , Z`i+ (� W Sou 14 nI
from the Owner listed above)
State or County LicenseC,�_�Z7Zq
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
_0 ar t m-,ime?
t .t
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: Jr --to& Q\CA06*k
_
Name: 664CGP,6T n4iyria64A f+At
Address: Ll9c)6-
Address: Lzzcc�csc WY
City: Fv-. ?I ai�_C,E State:
City: gTU to-r--t' State: F (_
Zip: 341I'$Z, Phone 77Z- 7aS- 6g657
Zip: 34,T 7 Phone: 77z Zz,l- Z.7 3
FEE SIMPLE TITLEHOLDER: XNotApplicable
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-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 in n. I intend to obtain financing, consult
with lender or an attorney before commencing work recordi g 0 otce of Commencement.
Signature of O r/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OFF}
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
thi day of2020 by
Name of person making stateme
Personally Know OR Produced Identification
Type of Identification
Produced
BARBRA A GoopmAM
(5ignature of Notary Public- Stat,@aMrLda ¢emmission#GG198133
Commission No. FQ016°0(S VA&NoN"ftwa�
Signature of Contactor/License Holder
ggt2
STATE OF FLORIDA 3 c>
COUNTY OF
Sw rn to (or affirmed) and subscribed before me of
4C
P sical Presence or Online Notarizatio c
this da of 202A, by L .3
�S�'�\"\.A 02 �
Name of person making statement.
.p' * o
Personally Known OR Produced Identifigation * S
Type of Identification
Produced
�o
1
AGOODMAN
(Signature of Notary
P ic- §tat'm
@Add March20,202Z
V � U d�` g�,c�NotalS�4Ms
Commission No. s
\ °F{�
REVIEWS
FRONT,
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20