HomeMy WebLinkAboutBuilding Permit Application (2)I
All APPLICABLE INFO MUST BE COMPLETL-.-`DR APPLICATION TO BE ACCEPTED
Date: ylli-��-� Permit NumberJ10Y. 1%06
9 1Po bL1CIl�
90
0"'1 �-Y 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:
PROPOSED IMPROV;EM:ENT LOCATION:
Address:
Property Tax ID #: 3qA2_ -7dG' - emol ' 000-6 I-r^&— Lot No. f
Site Plan Name: Block No.
Project Name: C_hP` q4o 0h,21' Qyd&n
DETAILEQ DESCRI;PTI;ON-OF WORK:
New Electrical Meter _� Second Electrical Meter
1"CONSTkQ.- &[O4 I.NFORMATI-ON:
Additional work to be performed under this permit- check all that apply:
kl Mechanical _ Gas Tank _ Gas Piping _Shutters
l ' ectric _ Plumbing _ Sprinklers _ Generator
✓Windows/Doors _ Pond
Zoof 6 11'2- Pitch
Total Sq. Ft of Construction: 177q6 Sq. Ft. of First Floor: 2,7 q
4�
Cost of Construction: $ 1-M 9676 Utilities: —Sewer Zeptic Building Height:
OWNER/LESSEE: -
_. ,
CONTRACTOR:
Name ar 6► vszher G®(4ta-F
Name:fnait, /Yjemi W 16
Address: 5-57ySr
Company: �� f
City: E-2�& Pc-19-mce_ State: FL,
Zip Code:q Fax: Ili �F'f
Phone No... 72-q 16^!2fc):T
Address:
City: Stater.
Zip Code: 2eigiK Fax: W4
Phone No ?72-336- 0052�
E-Mail: _r;� {� pa„fD� alai 044
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail P5/ Mropol 4r`4 . c_qwi
State or County License G 6 0
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.
`SUPRLEIVIENTALCONSTRUCTION LIEN LAW.INFORMATION:
DESIGN ER/ENGINEER:I _ Not Applicable
MORTGAGE COMPANY: >r-Not Applicable
Name:P,auL GyeiC-+tJr. i A c.
Name:
Address: l Q S'k 5 ki Ui t +rmyr e. iA
Address:
City. SL State:L.
City: State:
Zip:3q!?5ry Phone 27- 5"'g129
Zip: Phone:
FEE SIMPLE TITLE HOLDER: JCNot 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 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 a jobsite before the first inspection. If you intend to obtain inancing, consult
with lender me fore commencingwork or recordingNotice of Co ncement.
Z XW
Signatur of Owner/ L see/Co tractor as Agent for Owner
Sign re of Contractor/Li ense Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF (11-
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
�1 Physical Presence or Online Notarization
this W day of J&QQt 2020 by
this day of bWP% i _ 202T by
Name of person making statement.
Name of person making statement.
Personally Known �_ OR Produced Identification
Personally Known X OR Produced Identification
Type of Identification
Type of Identification
Prod d
Qa'yq
Produced
r2 - r Z &_,j/1
(Sign atu a of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No.CG
Nota(yPublicStateofFlorida
C mission Noca298 aI e I
y.
Robin L Bowen
my rommission GG 288212
Notary Public State of Florida
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