HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE CON,_...)TED FOR APPLICATION TO BE ACCEPTEV
Date: Permit Number:
o AAOwn--
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:
PROPOSEDIMPROVEMENT LOCATION:. ",..
Address: (vIQ23 U'S. N•wq _1 ft, Pierce, FL 34-(a
Property Tax ID #: 1401� • Jz+ • 6002 •000 • + Lot No.
Site Plan Name: Block No.
Project Name: -iEASUiz>= �A�( A2GAiDE:
DETAILED bESCRI'PTION OF WORK:
e44)"8e7zoo D&ed) -V_15, COi'LnlEuP Q. 76
New Electrical Meter Second Electrical Meter
CO:NSTR:UCTI OU I NFORMATION:.
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: I (gyp Sq. Ft. of First Floor:
Cost of Construction: $ !a 9QD — Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE.,
CONTRACTOR:
_
Name: �. • M AVI ICJ Q 13I_tsTErL
Name CRkCE 611\M jAKlCO
Company: DZsTEr-_ SIlar t5 I` �
Address: 325 1%!'cctf. jS G
City: o�W CS9hG State:
Address: 10431 D 1 d 4L6L ,
Zip Code: 321 tab Fax:
City: N/er0 b& State: r
Zip Code: 32-9(00 Fax::?-72 Sfv?^ 98/3
Phone No �7Z 5[P2 �Zlv3.
E-Mai : —�� Q►�
Fill in fee simple Title Holder on next page (if different
E-Mail br6&51gn!�-@GAI .com
State or County License 1%s 120D 1�0I3,, 1.�J '
from the Owner listed above)
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-1AW INFORMATION.
DESIGNER/ENGINEER: _ Not Applicable
Name:1244P_iSrlt iJ L M 67LEy' '*038z
Address: I Zoa W. Fc-DoZAL, I h 4V 02oo
City: F206A IZAni-4 State: FL,
Zip: 3343y Phone ASS 371 • 5113
FEE SIMPLE TITLE HOLDER: ✓ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone: -
BONDING COMPANY:
Name:_
Address:
City:
Zip:
Phone:
✓ Not Applicable
State:
✓ Not Applicable
UwnrvCK/ I.UIV 1 KAL I UK At I IUVI 1: 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
WA KING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
J�cpi
rovements to your property. A Notice of Commencement must be recorded in the public records of St.
e County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
th lender or an attornev before commencine work nr recording vniir Nntira of rnmmanrnmant
Si fu`re_o nelJjlessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STA E OF FLORPA
COU TY OF 2- L cl_L'
STATE OF FLORIDA
.i e.
COUNTY OF
Swor o (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence r Online Notarization
Physical Presence or Online Notarization
this �ay of 2020 by
this 't-day of IVIA,14202f by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
;Prod
Vd
Signary Public- State of I r'
(Signature of Notary Public- State of Florida )
;P� Notary Public S d Florida
Commission No. „ .Seal)
Commission No 00
• My commissIon G0107069
ExpiresoW22{2021
.s � PDIAN L. BRIANT
;io.�� °, Notary Public State of Florida
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Rev. 5/6/20