HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:( l 0�1'
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Building Permit Application
Manning and Development Services
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 IMPROVEMENT10CATION:
Ad .,
(dress:
Prlloperty Tax ID#: �30��- 6-0(2- 19,915-3" 0010 —� Lot No. �0
Site Plan Name: 9"Lj!� CY eek V&t5f!-& Block No.
Project Name: �2T1 NUV/TS
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DETAILED DESCRIPTION-:OF WORK'
..
tW 6c)os 2u elm/L) S1 C-S/o&f t' fti/se
Mot, CovrRAUZIL
New Electrical Meter Second Electrical Meter
CONSTRUCTION IN'FORIVIATI IN::
Additional work to be perf med under this sp�permit-check all that apply: �
�M hanical G s Tank V'Gas Piping _Shutters -Windows/Doors _Pond
Electric _Plumbing sprinklers �_Generator " Roof Pitch
L 4310
Total Sq. Ft of Construction: 6j�� Sq:Ft. of First Floor:
C ost of Construction: $_ ����UGC Utilities: —Sewer �eptic Building Height:
,OWNER/LESS;EE: CONTRACTOR:
Name�H'N S'ZT'tNk011115=6RJi0) .' �me: L J TG2 5
Address: SZO A/- 04614 V 02: i'' Company: 7-EZe56 841I L.IOG-S "&
City: Rill e� 4617 2# State: ff, Address: AkQ 51'C�/J8 4
Zip Code: 33'410!1 Fax: City: 81T,6F4P619 State: /`-c
Phone No. Zip Code: 0y �(p Fax:
E-Mail: Phone No � -� o yy q�
Fill in fee simple Title Holder on next page(if different E-Mail T�ZNC� � � nt'/UEfi
from the Owner listed above) State or County License 610/5�u/'53
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.
I
jk AN e�DI-nt S7-TpNKOVITS TIZI,1STC-6 or- -nt6 MI'Tit 5ZTANKovIr5 REvo6f-"5Le7RuSr
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SUPPLEMENTAL CONSTR.UCTIONLIEN�LAW IN;FORMATIO,N
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: S RAU1� W�LLA Name:
Address: l G� ?/-2_1� Address:
City: (E�� State: FL- City: State:
Zip: 98 Phone 17 85'6kfbS Zip: Phone:
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 our Notice of Commencement.
Signs ure of Owner/Lessee/Contractor as Agent for Owner ignature of ontractor/License Holder
STATE OF FLORIDA �IJG/� FLORIDA S7
COUNTY OF C COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
�Physical Presence or Online Notarization Physical Presence or Online Notarization
this t--7 day of J ,20W by this day of 29W by
V-0 V 1 T-5 -'5Z_6 sc
Name of person making statement. tName of person making statement.
f Personally Known OR Produced Identification _ Personally Known !C OR Produced Identification
I Type of Identifica io j' Type of Identification
Produced �: ^ Produced
( ig ature of NotaryE
1 - 0 1 a 4n_ ature of Notary Publ'M
t�t f F ref �b1ic state of F
y.%Y otary Public tate of Florida
Desiree Flexen Desiree F(exen
Com i ion No. My Comrr isl ar' 0 Commission No. MMy C n 2P zaoses
�fj5 OL9& aw. Expires07/22/2 22
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20