HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ~~��
Date: / �-' Permit Number: L 1 07 — 0 o /
Or LUQU
Buildin 'Permit Application
g pp
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: _/__�
roq
Property Tax ID#: -3 ®J7 T Y (7 oo,3 � eloo6
Site Plan Name:
Project Name:
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit— check all that apply:
_Mechanical — Gas Tank —Gas Piping _ Shutters
_ Electric _ Plumbing —Sprinklers _ Generator
Total Sq. Ft of Construction:��'
Cost of Construction: $
ResiderWAIV „
MAY I 1 207..1
Pirmitti;n,g Department
St. Lucie County
Lot No.
Block No.
_ Windows/Doors _ Pond
Sq. Ft. of First Floor:
Roof Pitch
Utilities: —Sewer —Septic Building Height:
"OWNER/LESSEAQ
E.
_.E�.
CONTR�gCTOR, r k * v
Name Elet C i >vh-2 1-
Name:
Address (9 P
Company: CQ �✓��
/ C
City: cz_ a J A' L C/G , State: `
Address: 19 l 2
v, U Iv,zt-
City: N1� f �a r`
Bec. State: f
Zip Code: M Fax:
/
Phone No. �7 6 - / 6
Zip Code: -3 _3/ 3
Fax:
E-Mail:
Phone No
9—
Fill in fee simple Title Holder on next page ( if different
E-MaU. U te. r
-3
from the Owner listed above)
State or County License
4:C /S
if value of construction is 2500 or more, a RECORDED Notice of Commencement is requires.
if value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CO�NSTRUCT)QN LIEN�L,AW lNFOYRMATIO,N'�� a ; �,��� : �s ;�
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DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ 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 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 attornev before commencine work or recording vour Notice of Commencement.
"U
Signature o Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA//
STATE OF FLORIDA
COUNTY OF '7� f �i�,�'�l.
COUNTY OF
Sworn o (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Presence or Online Notarization
Th71_s_ZL day of M.14 202f by
this day of IM-41 202V by
Name offierson making statement.
Name o erson making statement.
L-O�OR
R Identification
Personally Known Produced Identification
Personally Known _Le:f�_O Produced
Type of Identification
Type of Identification
Produced /
Produced
(Signature of Notary Public-r�ida)RUTH
L•
(Si ature of Notary Public
lorida L. LOPEZ
80MMISSION
'W COMMISSION # GG 294
71
.i W
# GG 2049Commission
",�,
No.
= (SRES:January24,20
Co ission No
. o�,S:January24,2023
F
•.. F F:N`•• ijmm rU NQWy Pub5c UWe
•.• F �••`�, TIIu Notm Pubric Underwil
REVIEWS
FRONT
ZONING
SUPERVISOR,
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Itev. 516125
All APPLICABLEINFOINFO MUST BE
2-1 i 1 1
Date: �'
.' ETED FOR APPLICATION TO BE ACCEPTED'--'
Permit Number:
J czGC
C
d � q
Planning and Development Services
Building. and.Code.Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PECEiVEd
Iding Permit Application APR 2 8 2021
6� �q Dent
,ucicz 'tyCommercial Residen �
PERMIT APPLICATION FOR: S I b 14
Address:
Property Tax ID. #:
.Site ,Plan .Name:
Project Name:
E- EST)
3L') 9!
02)9 0 o0
pETALLEQ DESCRIPTION OF VIlORK ;
-
00-0
tiC w Poe X i - 4L 260'1
New Electrical Meter Second Electrical Meter
J,CONSTRUCTION IIVFORiSIIAT(ON
Lot No.-
Block No. 29�
Additional work.to.be performed under this permit- check all that apply:
_Mechanical r Gas Tank _ Gas Piping _ Shutters _ Windows/Doors Pond
_ Electric _.Plumbing — Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:/, ' y, VL Sq. Ft. of First Floor: _
Cost of Construction: $ 1, UUUtilities: —Sewer _Septic
Building Height:
QWNER/LESSEE _ f
CON;TRACT®R
Name 1 %S
Name:
'_
Address: 7 l`T 6 ivy J PIL
Company:
e .
City: POAT 'ST lubt State: FL.
Address:
Zip Code: � Fax:
City: A lfly) I '(064
State:P
Phone No. -1 7 Z ° (g 24D • ll 14Z
Zip Code: 3� 13 Fax:
E-Mall:
Phone No
Fill in fee simple Title Holder on next page'( if different
E-Mail To ,4�)�ff C
,','7 ?
from the Owner fisted above)
_
State or County License 0-6
If Value of construction is 75nn nr o„nra a RFr nDnrn um. —
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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SU0PiiMt011TAL CONSTRUCTtON,LiEN LAW INFORMATION:
_
DES(GNER/Eli(PINEER: Not Applicable" NIORTGAQBE COMPANY:: Not Applicable
— . .,
Name: ' #s Name:
6icidress: "Address: "
,
City State: State: .
Zrp: ::Phone° zip., phone.
.
" °
FEE'S(IUIPTl6iElflOLDE� NotAbplicabYe [IOND)G COI@i(PA'l: Wot AppPscabiA
;N3ttl�
"Name. "
Address:� Address:
City: tit. City:
a
Zip Phone: Zip
: 'Phone:.
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated
I oertify Yhat no'work;or installation has commenced"prior` to the issuance of a permit. -
St. Lucie d`oumteyyrnakes°no representation that 'isgriiiating aperrnit Twill authorize'the perinit"holder to build the subject structure
Which is in confiPct 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 rile granimg of this teques8ed:pg' it, limo hereby agree that I will, "in all respects, perform the maork„
in accordance w" h the `a" roved° g
.pp plans; L Florida "Idin Code"s'and'St: Lucie County �neridments::
The folioaring biaildmg permit applications;are exerdpt from undergoing a fu0 wncurrency review: room additions,"
accessory stracta Pes, i e6ming pools, fences, walls,, signs, screen rooms anal aeoessory' uses to another noirresidim ai use •'
"WlkRNING TO j®WIVE c Your failure to Record a,Notiee of C®orlrrtententent it9<sy result in paying t Ace 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. Ifyou intend to obtain financing, consult
e, 'with lenderoran:a a before commencin work or recordin our Notice of Commencement.
'Sig erJ Les6ee/Contiacwr asp Agent for Owner Signature7of Contragtor%License Holder
STATE>QFM
DRIODA
STATE-IMF°FLORIDA,
COUOY ®F i L COUNT' ®F�y'"
Sworn to {or of tined) and.sobscribed before me of Sworn to (or affirmed)" and subscribed before me of
j..' _Physical Presence u Online Notarization L_1h sicaI Pre c or Online Notarization
this o'Za da 'of ° a 202o 'b `
y this day of 2020 by.
- fame o-personmake� statement
7
i Name of p n,makirtgsta ement.
Personally Know h , Lam! ° OR Produced Ide b
n Cica¢aon� Personally Kna!e n OR Pr®ducsd Identlb Lion
T mf tdrotsiica8ore
. ;� Type of Identification ----.
Produced",Produced
(Signature of Nota
t� RUTH L. LOPEZ Signature o Public- State of Florida )
L- Commission Flo. ����' `?
! es My COMf=4PN #GG 294971 1
24 2 Commission No.
EXPIRES: January ,
7 Pubk Undo flWs a° % R�7i1 L I
�• ,�. 7
EY/lE4�15° -°FROND` � �®NIA{(; SUPERVISOR, PCAP9S '> VEGETATION CCiO�3TER.: RE�ld!
R VIEVy a= REVIEW ° '�fe �REVI ° ` a .DATE � � EVtE
r.
° �R
3,. .RECEIi�Et
EVOEti�!
PATC
COMPLETED
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