HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Y 1 y I al Permit Number:
_
��a n ���� [RECEIVED
O L, OCT 0 7 2020
Building Permit Application . St,I._CIaCounty
Planning and Development Services
s+niKing
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
,PROPOSED IMPROVEMENTLOCATIOIV '..?
Address: Li Q 3 Ce!1 ui:a Ave.
Property Tax ID #: 1301 - (.()S- 610 a 000- g Lot No. 2 R
Site Plan Name:. Lal<e . cN ooj Olur l( Block No. R\
Project Name:
DETAILEDDESCR1PTION;OFWORK:
54na_I0__ ram ; L.4 S i-A_ S It 5 yn,v / ,2 T���e.
.New Electrical. Meter Second Electrical Meter
G
''CONSTRUCTIOM°INFORMATION:
.,. ,...
Additional work to be performed under this :permit -check all that apply:
✓Mechanical. _ Gas Tank _ Gas Piping _ Shutters t indows/Doors . _ Pond
V61ectric VIPl u m b i n g _Sprinklers _Generator ✓Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: i J
Cost of Construction: $ ( $O+ oa o Utilities: —Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:.
Name �. Lwc;e b ; or -�
Name: S A. LcA�ci e I�a.�: � �a r I-�u.,ta.�`Lf
•
Address:_ 70'._� S G '.54..
T
Company:.. 10
City: State: ,pL
Address: 702 % 6, S 1
Zip Code: 3 `i 46'o Fax:
City: EL P i l c-i-e. State:,.
Phone No. 772- y.Gcl -1/ l 7 .
Zip Code: T q IYJ-b Fax:
E-Mail:joSePIA0
Phone No 772.- c16q-1117
E-Mail 3oSg Dk °1 Si is cj a ka1.,+4J . 06-4
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License FsS c/Fj I r X<MO 7
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
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: "f)Je_koSe I
Address: 44 z'l 6'-
Name:
Address: 762 5N 6 ", S�
City: C-A.R;trce_ State: - FL
Zip: rHqq(. - Phone (772) 'Yo - [On g
City: State: FL
Zi p: 5 14 5 C0 Phone: '7-2<a - 9 (p q _11 0
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 attorney before commencing work or recording your Notice of Commencement.
Owner/ Lessee/Contractoy7as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF_
STATE OF FL0131_DA
COUNTY OF t>T. 11-440-46
Sworn to (or affirmed) and subscribed before me of
�( Physical Presence or — Online Notarization
this —je- day of 6g:=F� 2021 by
Sworn to (or affirmed) and subscribed before me of
)( Iysical Presence or Online Notarization
this to day of jV61D (39:2 2024 by
Name of person making statement.
Name of person making statement.
Persongily Known )C OR Produced Identification
Type of Identification
Pro cad
Personally Known X_ OR Produced Identification
Type of Identification
Produced
'Via�ture of �Nt ry Public-
Jky PU, TONYA R. MILI-,
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CommissionNo664h q - ' 1% to , Public -State of FI
*Nwission # GG 918
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