HomeMy WebLinkAboutBuilding Permit Application - Buckeye Dr I
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
94o LUC
O
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Plerce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 61IS
Property Tax ID 4: 3�� �� ��(F 0(3 0 lD Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit—check all that apply:
—Mechanicat _Gas Tank —Gas Piping _Shutters Windows/Doors _Pond
_Electric —Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: 'Zk h Sq.Ft.of First Floor: Zl�n
Cost of Construction: $ g o 0 Utilities: —Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name cle- Name: MmA�V SWIDOV
Address: R1S )6QC�QM1b � Company: Ili"A -&Alti�J�►^l�S -
City:�' 'P I�C�G�G State: Address: YLP
Zip Code: �Li Fax: City: {�" Gq(J Slate:
Phone No. 7 2-C13 3 Zip Code: L� �_ Fax:
E-Mail: Phone No n 2u
cq
Fill in fee simple Title Holder on next page(if different E-Ma N—KtP4ij,QEQvpkl::�e,_WAPf
from the Owner listed above) State or County License 2S`1 U
I
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:
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 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 recordin our Not' Commencement.
Signatdre of Owner/Lessee Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF5oin�,Woe, COUNTYOF
Sworn to(or affirmed)and subscribed before me of Swg�n to(or affirmed)and subscribed before me of
Physical Presence or Online Notarization 7`" Physical Presence or Online Notarization
this�411ay of OC ,2020 by this 2.A day of 0MY7FZ'— 2020 by
Ma � C�o4l-o4 L-12L4�M�1�2
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 M
�N►ttt11HI1HH/�j ►H�INf1�////i
\AEW C //ij
T1 Fn
(Signature of Notary Public-State QF'FRFida,M sio O,y4� (Signature 4Notary Public-State of Florida L2� • .
Commission No. = •�(�eal) inn _ Commission No. 5�a1)
M111 Q5 W S 2.• iAiH 101177
.�•••.�d°qtl 6 % .2y onde4�h acre .
REVIEWS FRONT Z' G.`fJiA • R PLANS VEGETATION SEA TURTLC�i
COUNTER RE REVIEW REVIEW REVIEW
DATE
qH NI of 1tNttHF
RECEIVED
DATE
COMPLETED
ev.
Owner Authorization Letter
C
Job Site Address;
Homeowner's Name:-, 0ho �a��}�p� _�..._......_._.___
I,--lr,,Y' j L�-,-I `f`, �'1 due hereby authorize Matthew Shanley,Alpha Foundations
Specialists Inc,to apply for a permit to perform remediation work for my property located at the address
referenced above. Matthew Shanley is also authorized to sign any and all permit aplications and
documents needed to obtain the permit for this work on my behalf.
Sincerely,
(Home Owners Signature)
State of Florida
Countyof SQt!lt (Wit
Sworn to me on this4 day of C&tx'r 2 r by � �VE (6(Kho is
personally known to me or who has produced the following as identification: b� eAy _T
Notary Signature \\\\`gN� 1liuU��rlr�i
44
i�
•c ,
• ,�Notary Name �*t