HomeMy WebLinkAbout5201 S Header Canal PERMIT AND DRAWINGSAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l0 - 4 - 12021
Permit Number;
C) 4 \
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commerciai ✓ Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1570 C8DG Funding
PERMIT APPLICATION FOR: N-evv ,2-00 rn P 5rYI/1 ce
Address:
Property Tax ID k: 32 02= -'600 -CX DW - C=- - 3 Lot No.
Site Plan Name: Proms-ttky Po-t7c.het-feS Block No.
Project Name: 6 r S Se ll - Se rV i C e
n ,ierul (`-2
New Electrical Meter ✓ Second Electrical Meter --._...____ (Affidavit requi«-d)
Additional work to be performed under this permit -check all that apply:
Mechanical
E ectric
Gas Tank
F Plumbing
Total Sq, Ft of Construction:
Cost of Construction: $ __�2 60 0 aG
Name —
_ Gas Piping Shutters _ Windows/Doors Pond
M Sprinklers — Generator _ Roof Pitch
Sq. Ft. of First Floor:.
l.10ities: Sewer __... SrpUr Building Haight:
Address: 5zo I 5 IffgplQR (`anal Rd__
City: (?�! fi �s�}C-- state: i t
Zip Code: 3q9 f % Fax:
Phone No. - t 0 / 5
mail: d aSOn P S)e lt,S/2, ll e f"
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name:
Company: 10 ki C-U-0-Y I r
Address: �D3�w�oaxr �>-
city: Tjos2j eU ,YC1I State: LL-
Zip Code:.-Le�-, Fax: -T72-2 C -S42 Y
Phone No —112- 2I tp - 2g4_
E-Mall Q q,Q SL�1�, (121
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is requ
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
;PLEMENTAt. ONSTR; CiIOh,LEcNLAV4JN;''rRMATIC)N:
DESIGNER/ENGINEER: VNotApplicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: = Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: ✓ Not Applicable
Name:
Address:
City: State:
Zip: _TPhone: /
BONDING COMPANY: -Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIOVIT: Application is hereby made to obtain a permit to do the work and installation as Indicated.
certify that no work or installation has commenced prior to the issuance of a permit,
St. Lucie County makes no representation that is ranting a permit will authorize the permit holder to build the subject structure
which conflicts with an applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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 attoanev before commencine work or recording vour Nntirp of rnmmpnrgirri
Signature of caner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF apf l
�hysical
Sworn to (or affirmed) and subscribed before me of
Presence or Online Notarization
this -14 day of OCXObCR 2021 by —�
'T
_ a pt isy $-- ink L) Ise- R'S G i J
Name of person making statement.
Personally Known ✓ OR Produced Identification
Type oflld�entific:aatiion Produced Dn fl2YC
(Signature o Notary Public -State of Florida)
�ra '
Commission No. 4SG35cf7 % 8 (Seal)
�"Notary
TAYLOR M JONES
E
Public - State of FloridaCommissionx
GG 359418
h,
Comm.Expires Jul 28, 2023
Bonded through National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
_
COMPLETED
11 ev .J/ 4./ S l
I
I
I
I
'ROP DSEo
I
I
I
I
I
�
I
I
A _
I
I
I
I
Qa
I
6
fl
I
I
I .
I
e-
a
Ima
lac
I�z
L
4
m� p, I
mazy
I o
-n
s;=_�
D'
O
of
I I I
DCO
Oq�nrj
S
Q
VO
Z Q_
p
m
I<I I
am
1
> I I
m
>< f
KI
_-------J—
b
�
O
— — — — — — — — _
TOP OF BANK
'+.j.' TOP OF BANK
P
— (/�.
I
'
DITCH
INY FL CA 1� 'f�' EL M23
�S� yy, DITCH
xp/
r
_
o
Oo
a
y.
— — — — —
- ` ?�
'U
TOP OF BANK —
— — —
—
— — I TOP
OF BANK
—S•
0-21`25
300.b
S.S.
_.
NV EL*VAJ I4V FL 21.62
Slrt& PLRN
4A G-&
00
��osed I
SITE, PL-ftN)
Sim $iSSet_L
s2o► S t�eodR-� ca�a..� �d
1-z
M