HomeMy WebLinkAboutBuilding Permit Application'All APPLICABLE INFO MUST BE COMF_LL�'§'ED FOR APPLICATION TO BE ACCEPTED' /
Date: Permit Number: 2 Ob_ 01 0Y
Or. [Luc H f E --
Building Permit Application
Planning and Development Services / �9�c+'0�4�
Building and Code Regulation Division Commercial i/ Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: fob 93 as LIAI,S4 I a° Pew. kti %- 3y q ,( l
Property Tax ID #: N06 - I'aS - 000Q ono - Lot No.-',
Site Plan Name: Block No.
Project Name: E614 fICNAAS
DETAILED DESCRIPTION OF WORK:
/� pp_
`rAAQA1V, n d14A' it
New Electrical Meter Second Electrical Meter ;x
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Windows/Doors _ Pond
Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ (1 _ _ Utilities: —Sewer —Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Address: 1PyXJ4 45,Ob 4 A44
Name: MS-IAyA AP-16119
Company:
Address: b l
City: rr State: V .
Zip Code: /„ 0 Fax: -7 7 1
Phone No. -7,) "�p�13
E-Mail: r-I'i41M1&Am (%A Eb nr�a 4+
City: V" State: -EL.
Zip Code: `� t (o (� Fax:
Phone No
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail �l&-iW <-Larva ah a-& CYV-%
State or County License sn� IC
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:
DESIGNE ENGINEER•
_ Not Applicable
MORTGAGE COMPANY: _Not Applicable
Name:
Name:
Address: "
'#
Address:
City: Ig. (per.
State: 17(-_
City: State:
Zip: Phone 1-9,<9-
371 - 3113
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
__\ZCot Applicable
BONDING COMPANY: _1:,,,PQot 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 inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording your Notice of Commencement.
ature of Own
as Agent for Owner
STATE OF FL
O ID
COUNTY • L f'.� G,' t�
Swor to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this P day of J LLNe_ 2020 by
cYC1Ct CDINQ.VYv�WC,6
Name of person making statement.
Personally Known OR,Produced Identification
Type of Identification
Prod ticed�!� SHARONLGRI
Co a� HH
�C1 GfaM "_ .s Exniraa xnr..� U_ aft
(Signature of Notary Public- State of Flo aL saaatirui Noi�
Commission No. d1l DY (Seal)
Signature of C ntractor/License Holder
STATE OF FLORIDA
COUNTY OFInc,,jg"*
�Sworn (or affirmed) and subscribed before me of
sical Pres nce or Online Notarization
thisnn t day of 2029 by
Name of person making statement.
Personally Known Ul-.1"OR Produced Identification
Type of Identification
Produced
of Notary Public' State of Florida )
Commission N
4rRYoff'••. t5ea1) DIANA L. BRYANT
Notary Public • State of Flor
A�- Cnmmicsinn It GG 94nnl l
of?:' My C
mm. Expires Feb 22, 2
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Rev. 5/b/20