HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ,pp
Date: Permit Number: 10 0 D 0
>i L Co, C. [!yL tz = Building Permit App �-u�je lication perm�ttl"cj untent
St•
Planning and Development Services
BuildingandCode Regulation.Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)4624553 Fax: (772)462-1578.
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address:_,j d 1 �l'3�Cr 6��Eli( \ O l2 S-i�"i I►U i L UGC( V L
Property Tax ID#:� 5 50F —�o3`i —610—'v� Lot No.
Site Plan Name: Block No.
Project Name: Re �?C 0�
l x
DETAILED DESCRIPTION OF WORK:
-;r` a.l-fli nei r-cl. G;/S c4ryy Sr i- o-►, 64,7 K cfA41 ra). p <,)Ig e
d>��� //u<c,► 1��PC1 S C.dnVY 5,1 " �a� cq�� �p„t.►t�c} v �ptsJf v
New Electrical Meter Second Electrical Meter. .
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit—check all that apply:
—Mechanical _Gas Tank —Gas Piping _Shutters. —Windows/Doors' _Pond
l-Electric _Plumbing _Sprinklers _Generator 9� _Roof Pitch
C�
Total Sq. Ft of Construction: A0 4 69ck <19 h Sq. Ft. of First Floor:
Cost of Construction: $7 ooa.deg• Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name:
Address: 14 b o OL� `14 Company: 7 C�
City: L)e State: �°R Address: -1
Zip Code:C),"7 >? L Fax: City:� J�b State: 1 L
Phone No. Zip Code: 2akY Fax:
E-Mail: Phone No R&g0a gbW
Fill in fee simple Title Holder on next page(if different' E-Mail T�a)00\.efirr►
from the Owner listed above) State or County LicenseEzclu
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: /1
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: tN Address:
City: I I x- 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.
Inconsideration 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 ou intend to obtain financing, consult
with lender or an attorneybefore commencingwork or recordingr Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Sign re f ontractor/License Holder
STATE OF FLORIDA STATE OF FLO DA
COUNTY OF COUNTY OF
Sworn to(or affirmed)and subscribed before me of Swor to(or affirmed)and subscribed before me of
Physical Presence or.Online Notarization ,-Ph ical Presence.or Online Notarization
this day of 12020 by this-Wdayof JUIM y
Name of person making statement. Name bf person making statement.
Personally Known OR Produced Identification Personally Known�OR Produced Identification
Type of Identification Type of Identification
Produced Produced el
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State FI "" '•): MARIA C pAMIANI
Notary Public State of I da
..
Commission No. (Seal) Commission No. �,'� `a11 Commission s GG 98 0
or ►M Comm.Expires Jul 1 24
Bonded through National Not ry ssn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW -REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.
CALII'-'.,:ANIA CERTIFICATE OF ACKU ILEDGNIENT
Yf oc.fxt C •n tT4 �+'lxih.0 .c••!vi
A notary public or other officer completing this certificate verifies only the identity of
the individual who signed the document to which this certificate is attached,and not
the truthfulness,accuracy,or validity of that document.
State of California )
County of f ??-em A w L )
On JMiltIq� Z UZI before me, S � � , '
CVI' ��"(al�l �U IIC _
(here insert name and title of the orfi er)
5
personally
p Y appeared
x, who proved to me on the basis of satisfactory evidence to be the personV whose name(4)Qre subs ed to
the within instrument and acknowled d to me that he s e they executed the same in hisheir
authorized capacity(i941 and that by his er their signatureW on the instrument the person(4, or the entity 4
upon behalf of which the personv acted,executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the
State of California that the foregoing paragraph is true and correct. DEANNA R.SPEER
COMM. #2344810 z
° a Notary Public-California o
z San Bernardino County
WITNESS my hand and official seal. My Comm,Expires Feb.2,2025 k
Signature � L� b��Cl/
(Seal)
i:pltu.v'
Optional Information
Although the information in this section is not required by law,it could prevent fraudulent removal and reattachment of this acknowledgment to an
unauthorized document and may prove useful to persons relying on the attached document.
Description of At Document
The preceding Certificate of Acknowledgment is attached to a document Method of Signer Identification
titled/for the purpose of Proved to me on the basis of satisfactory evidence:
`-' 0 form(s)of Identification Q credible witness(es)
--- Notarial event is detailed in notary journal on:
containing pages,and dated Page H Entry H
The signer(s) capacity or authority is/are as: Notary contact:
❑ Individual(s) Other
❑ Attorney-in-Fact [:] Additional Signer(s) ❑ Signer(s)Thumbprint(s)
❑ Corporate Officer(s)
Tltle(s) ❑
❑ Guardian/Conservator
❑ Partner-Limited/General
❑ Trustee(s)
❑ Other:
representing:
Name(s)of Person(s)or Entlty(ies)Signer Is Representing
4)Copyright 2007.2018 Notary Rotary,PO Box 4 H00,Des Molnes,IA 50311-0507. All Rights Reserved, Item Number 101772. Please contact your Authorized Reseller to purchase coples of this form.