HomeMy WebLinkAboutBuiding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED. 1
Date: 5� /Ig /� 1 Permit Number:
RECEI.-
OCT 0 8
Building Permit Application St. Lucie(,,,:
Planning and Development Services Permitting
Building and Code Regulation Division Commercial Residential V
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 4624578 .
PERMIT APPLICATION FOR;
PROPOSED IMPROVEMENTLOCATION:
_ate.,, � ,.•.�n•.
Address: 7s'03
Property Tax ID#: - i a Lot No. �
Site Plan Name: oys; , a .. Block No. ,
Project Name:
DETAILED' D..ESCRIPTIOkOF. WORK: r
[�G.r c�►. a d_ a_
New Electrical Meter f Second Electrical Meter
CONSTRUCTION INFORMATION - t; ,:. -'� ...•, ` ,
Additional work to be performed under this.permit— check all that apply:
✓Mechanical _Gas Tank _ Gas Piping _ Shutters Win
dows/Doors _ Pond
✓Electric W./Plumbing _ Sprinklers _ Generator J Roof Pitch
Total Sq. Ft of Construction: ), -7O 9 Sq. Ft. of First Floor: 1 2 0 9
Cost of Construction: $ o0a Utilities: _ Sewer; J(Septic Building. Height:
OWNER/LESSEE:
CONTRACTOR: n
Name S1 Lbr
Name::
L,�6 c- `- 41; N-kA- �4_W a,_47
Address:. 7b )L $ 0, �,
-Company:.
Address:
70a S Gyti 5 �.
City: State: LC.
Zip Code: 3 Q Fax:
City: T4.
State:__ff_�-
Phone No.i?a - c46 q—/1/7
Zip Code:
�3 y9s`o Fax:
E-Mail:
Phone No
E-Mail
7-7,:I —
ova, a .
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License F S 5 $ Q f �G-c•.0 d-,
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.
DESIGNER/ENGINEER: _ Not Applicable
Name: U \o6 heus Q CA e :c)z er;na
Address: qy S-1 1o1 .,cl
City: r4.O; 4 r ce- State:
Zip:? q 4 c Phone (772) y o 4- 1 iO3
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name: S*4,, U cte- IU60y.V ��
Address: -7o`a S C. " 51,
City: Fc,r-- V,, co-ce State:
Zip: - y Qso Phone: 1-ti- -16 Y-1117
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 vour Notice of Commencement.
Signahke of Owner/ Lessee/Contractor as Agent for Owner
Signa re of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Gr. L iC. iQ
COUNTY OF &T. L A0E!
Sworn to (or affirmed) and subs ' d before me of
Al
Sworn to (or affirmed) and sybs i d before me of
`
Physical Presence or nline Notarization
K Physical Presence or b nline Notarization
this laL day of ®f 2020 by
this K-L_ day of ®(n'0040 202 by
Name of person making statement.
Name of person making statement.
Personally Known X OR Produced Identification
Personally Known /K OR Produced Identification
Type of Identification
Type of Identification
Prod
Pr duc
R0�, TONYA R. MILLS
° Notary- Public -State o I
a �,��'�.;;;,,, TONYA R. MIL
a re f Notary Public- St a i a ommission '# GG 91
(S' ure otary Pub , I A�ission # GG 91627
°.,� My commission Expires
���"��"��� Oq ober 01, 2023
. My commission Ex
October 01, 202
Commission No.
ommission No.
Gci --9 10 �--15
C 0 03
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Rev. 5/b/ZO