HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE
Date: 1 _6 - 2vz'(
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FOR APPLICATION TO BE ACCEPTE[
Permit Number: &/Oq -/box
LUC o -
�'°`=p' Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential x
2300 Virginia Avenue, Fort Pierce FL 34982 ,
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED I'WROVEMENT LOCATION:
Address: (5'65" Kell !I ITT .
Property Tax ID #: �3l C
Site Plan Name: ;
Project Name: I ,4 re-Galp m-,
DETAILED DESCR'IFTION:OF WORK:
12 _ ., _ _a / .
CSC t� f4rz ,Gib
New Electrical Meter a- Second Electrical Meter
CONSTRU'CTI:O'N INF'ORMIATI`O'N`.
Lot N o._
7,&iock No.
Additional work to be performed under this permit- check all that apply:
Mechanical _ Gas Tank —Gas Piping _ Shutters Windows/Doors _ Pond
Electric Plumbing _ Sprinklers _ Generator )r- Roof 9 AL Pitch
Total Sq. Ft of Construction: 'Z32-Z Ste. I-'�'� Sq. Ft. of First Floor: 2, ' � 5,a, EL
Cost of Construction: $ �, ��, �2., Utilities: —Sewer Veptic Building Height:
I'OWN.ER/LESSEEI
CONTRACTOR:
Name Pa_ c eL and LJsse_f-�
Name: ill a -he -lra
Address: 1 ULI20 64AWef Cze:f 01Y Ad.
Company: PSL pre/
e5
City: 1�0�� 5�� L. c State: �.
Zip Code: 31716 Fax: rIIA
Phone No. /3/9/�
Address: 2 G L S Gc� ESL f
LVd.
City: &IL "a �.uu��
Zip Code:�iiSS_�/
Phone No 772-6ZC I/
Stater.
Fax:
76
E-Mail: IiOfi$
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail &,O 149 .'Yl
� _�`� , Ge In
r IF
State or County Licensel_
12 C, 0 11
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVGis. $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTALCONSTR�UCTtON`UEN LAW MFORM�ATIGN:
DESIGNER/ENG NEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name: gent nEA�, k is n.a -mod"
Name:
Address:
Address:
City: �r P"erc-'e— Stater
Zip:;3519,8q Phone
City: State:
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 arl,,attorneWbefore commencing work or recording o N.-ice of 99&en ment.
'_'fir" ."'.,." . -''s' 'y' r
r
C'� �'�- � F • � ,,, _-� � �
Signature of wner/ L see/Contractor as Agent for Owner
Signature f Contractor/L' ense Holder
STATE OF FLORIDA
COUNTY OF 67 —
STATE OF FLORIDA
COUNTY OFF U IC
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this USclay of 2024 by
Swo n to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of �� ('l l 2020 by
VyXR�Nz (Q 44iM II U2
vVi64 rL iv n4
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Ty—pe—ottnTeffication
Produced
RaP&^aaLW Known OR Produced Identification
Type of Identification
Produced
ON
(Sign atur f Notary Publi St dublicState ofFlorida
Robin L Bowen
Commission No `o My�ssionGG298212
:a, Ex Tres 04/2023
Flpwialg4 licstateofFlorida
Robin L Bowen
(Signature of Notary Pub i Td
Commission No. M Cq�n�mis�onGG298212
Expir@s710A/2023
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20