HomeMy WebLinkAboutBuildiing Permit Application - DakeAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10- 2 /-2 / Permit Number:
Luc
Q O
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982 r
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 5"-56)0
Property Tax ID #: 14136 -J / _C, 2 —OG'GS Lot No. A
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
Block No.
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2k/.S Cca»Lr'e- ? G,�a:�/ G�i'��� 7 S'�c.i� 6
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New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
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: .27A xf Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Cost of Construction: $ 13,2.00 Utilities: Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name �Cec!— , het,
Name: / X-- 4) 19&1,-,4 C-sL-
Address: S 5 U S� L r ti- f'`
✓31c�/
Company: f:2I �'f-/ /�l«.sic{
'
City: State: EL
Zip Code: `/ cl C/ Fax:
Phone No. / (c - E-
Address:
City: / P, e r r_-f —State:
Zip Code: MzS J Fax: 2 2--�)-L/Z�Z- 2,-1G3
Phone No 7 7-c/L-c/'��rG°C
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail 66
State or County License k i3caC/�/r-
if value of construction is 2500 or more, a RECORDED Notice of Commencement is requirea.
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
Name: FLORIDA ALUMINUM ENGINEERING
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:5601 MARINER ST.
Address:
City: TAMPA State: FL
Zip: 33609 Phone813-374-2403
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: �QATD FANN11Z(` —0-4-1f .# `K'e
BONDING COMPANY: Not Applicable
Name:
Address: !ASvco o,
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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE/JIRST INSPECTION. IF YOU INT D TO OBTAIN FINANCING, CONSULT
YOUR
WITH I FNnPR nR ON OTTnRIYKY Bt661RE RECORDING YOUR NO OF COMMENCEMEW."
Signature of wner/`Lessee/C rac Ag nt for Owner
Signatu of Contract /Df
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF ST LuG1 iff
COUNTY OF ST.. Lucie
The forgoing instrument was cknowledged before me
The forgoing instrument was acknowledged before me
this 1.+ day of 20 •1 by
this day of O� T�uSEK. 20_?_I by
E[ AKLES J • OE-tcV�EFt.
_Ci4-AP-LE1 T. OlrkuEIL
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known L____ OR Produced Identification
Type of Identification
Type of Identification
Produced
ProducedMULWAN _
(Signature of Notary Public- St or
NOTARY PUBLIC
OF FLORID A
Commission No. & 7 � z �STeal
(Signature of Notary Public- Stag riA H H A
NOTARY PUBLIC
Commission No. C 34 0 a s OF FLORIDA
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GG973640
GG973CAO
E I Expires 3/26/2024
E I Expires 3/26/2024
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19