HomeMy WebLinkAboutUpdated Signed Building Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
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Q Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fart Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 4624578
PERMITAPPLICATION FOR: v5mv �s1a1 iio
PROPOSED IMPROVEMENT LOCATION:
Address: \�J W�%r\Q S 1QA\JC�� Sei�S�n �IIaS
Property Tax lD#: L4 bOa ` 504 " C)1C\C\ 000 a Lot No,
Site Plan Name: Block No,
Project Name:
DETAILED DESCRIPTION OF WORK:
Pao oA 1;CkQok to l;M, . ii- Ilok
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Addltlonalworktobeperformed underthispermit—checi<allthatapply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Pond
Electric _ Plumbing _Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ J I a U
Sq. Ft, of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name S0\0A \`,QXQ iWV
Name:_'�\+Vt C\kt)Q\v. V%\&%ng:ltnc
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Address:\3 N 04c% (31yc1
Company: 5%CfJ%E%(�',
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City: �C(\SCR (�Ca c1n State' L
Zip Code:ZrL,\D1S ' Fax:
Phone No..Us 1 " 0 %1' - 'J2 Ccj I
Address ll I t7 S'r T ec� arz 1 Nw�
City"NO SbUOA
Zip Code:3341 S 5
Phone No 5 CQ I C¢\ aL i
State\
Fax:
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E-Mail: M*) f\ IC � 000C9 �C-Fi-\-,. �1�
Fill in fee simple Title Holder on next page( If different
from the Owner listed above)
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State or County License CC &
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If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC Is $7,500 or more, a RECORDED Notice of Commencement Is required,
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SURPLEAsyf /.ENT4 30TVST[iUGTpN 11ENP1 1(�FORI�IATjON„
DESIGNER/ENGINEER: _ Not Applicable
1 � , a Y 1 r,
OMPANY: Y Not Applicable
Name:
Address:
EAddress:
State: _
Phone;
City: State:
Zip; Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: Not Applicable
_
Name:
Name:
Address:
Address:
Clty:
City:
Zip: Phone:
zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application Is hereby made to obtain a permitto do thework and Installation as Indicated.
I certify that no work or Installation has commenced prior to the issuance of a permit.
Sk, Lucie Count makes no represe Cation that Is granting a permit will aut�arize the permit holder to build the subjects ructure
which is In conflict with any applica� a Home Owners Association rules, by i 4r and covenants that may re$trie� or pr hibit such
structure. Please consult with your �ome 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 peying 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 ran attorne before commencin work or recordin our Notice of Commencement,
Sign o wner/Lessee/Contractor as Agent for Owner
SiTE OF FL RDA
COUNTY OF
Sworn to (or affirmed) a subscribed before me of NThysical Presence or _ Onilne Notarization
this,. day of ::S�A \�, 20Lk by 'e .
Name of person making statement,
Personally Known OR Produced Identification �_i—
Type of Identification ProducedSV�1l"i--
(signature of Notary Public -State of Florida) 1° Notary Public St►t9 of Florida
Amanda Elliott
Commission No. (Seal) Via, My Commission GG 936496
zoTO Expires 12101/2023
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev 5120/21