HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COlbirCeTED FOR APPLICATION TO BE ACCEPTEC , _j
Date: Permit Number: 2-115 b
O ` RECEIVED
Building Permit Application SUM 11 7..
Planning and Development Services Permitting Department
.
Building and Code Regulation Division Commercial ResidentStial ucie County
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
K.UPOTEDoa VEMENT L'OCATI:ON�
Address: I o 1 o 7- S DUl 0(ulv'a- (j Pr a -e c i
Property Tax ID#:b-)-'4So3'doSy -0o0 -( 69-_V `'` Lot No.
Site Plan Name: S -er - ' G °' F*i--r�
i1 _ Block No.
Project Name: /-t- _C_ k S � S �� - �� �� �r�Tr•,
DETAILEDDESCRIPTION `OF WORK. `
�''1S ��- 1 a �yr• el (J► °• F e S c�Sy-cam d- C C-/-"I I— r- , 4 r—
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFO.RMATIO'N F , .
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: J Sq. Ft. of First Floor: _
Cost of Construction: $jj 0t1 Sa up s�/►`(r V-I Utilities: _Sewer _Septic
Building Height:
01NNER%LESSEE'
;.
CONTRACTOR •- _-
Name �'t-��nri /
S b� r �-eti �an�a I1/ a
/1SS C
. , . ,. ,. ;•,°: . ,,,-,� .
Lcl
Name: uS 2 5
Company:--nYo-le 4cCe _S5 5 _eS
Address: / 3& / s w 2T4-, J4
City: �0� Ipc r,'o(=C-
State:
Zip Code: 3 3 0 io 9 Fax:
Phone No '>_0CIO �
E-Mail l_USse( @ %Lo-S (_ Or-\
Address:10 101 Ucgf,
City: 31C1r\S•er\ L State:l�(-
Zip Code: 3�'l(9 S Fax:
�i
Phone No.
E-MaiI_TP-CC k' We, LA C6v-�
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
If WMI110 of rnnetr....►:....:.. 'frnn
State or County License C O 4 a--q-? 9 �
--- -- -----....--.�, ••���..��� �.Wc U� %.unnnencemenr Is requlrea.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
-_l
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City:. State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: ,_ 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 r 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 attornev before commencingwork or recording vour Notice of Commencement.
Sig ature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA n� ^
COUNTY OF &,rlt/k,
COUNTY OF 0 V L
S o :n to (or affirmed) and subscribed before me of
Physical Presence or Online NotarizationPhy
Sw r to (or affirmed) and subscribed before me of
ical Presence or Online Notarization
":J-Lt
this3/(day of.2020 by
this ay of ,►tee . 2020 by
1ZL ��LA
V1_.s s*-P- I ti_( )ins GI
Name of person making statement.
Name of person making statement.
Personally Known Y OR Produced Identification
Personally Known X OR Produced Identification
Type of Identification
Type of Identification
Prod d
Produced
(SigniAure of Notary - �! lea
�� NOTARY PUBLIC
(Signat re of Notary Publi - Stat f FhQ a )
��SAkYq �ynl is Mane Bean
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Commission No. a. =STATE OFF I A
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W Comm# GG195204
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Commission No. kJ
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Expires 4/201
022
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