HomeMy WebLinkAboutBuilding Permit App - Jones All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: rr?? Permit Number:
27.
� ,L Y°,-`B1"Y-0 ° �N Building Permit Application
Planning 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 CBDG Funding
PERMIT APPLICATION FOR: Per� -�k
PROPOSED IM'PROVEMENT:LOCAT[OK
Address: `73 5 ln� 4�v\-ar-
Property Tax ID#: �'3
�2. o - 3 - Doo3 p 0 Lot No.
Site Plan Name: fDKZ5 /�,,,,Snn?Ot'�G2 _ Block No.
Project Name: 5 0_" I6Id-e;qG2.
DETAILED USCRIPTI.ON-OF WORK:
IV� f&I L<-h,V7 irn waG�
olrS
New Electrical Meter Second Electrical Mete? .(Affidavit required)
CONSTRUCTION INF.ORMATI:O.N _
Additional work to be performed under this permit-check all that apply:
_Mechanical Gas Tank Gas Piping _Shutterslindows/Doors Pond
Electric Plumbing Sprinklers Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor: IS-60
Cost of Construction:$ I ZOC D Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CO'NTRACTOR"-
Name Y- S Name: Am ch yl S mc;ootnvN�P, 11
Address: S !• Or Company: C64 eoy u] ou Cep
City: pfe' r4r-C State: l�I- Address: -e a�VC-1
Zip Code: g z Fax: City: 'FYL State: IGL
Phone No. :2-?Z 7v��- 43(Q t E•- Zip Code: 3(flgCp Fax:
Mail: Phone No -77 2 r s,3c', r SYko
Fill in fee simple Title-Holder on next page(if different E-Mail Y- budd IPIQ akvq,Se .CZYK,
from the Owner listed above) State or County License C Daz
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: �____N-ot Applicable
Name: y .e- Name:
Address:`22Cv__ RV_?_ Add ress:
City: arG-e State:�L_ City: State:
Zip: Phone_'?-?Z ' (O0 23 X1 Zip: Phone:
FEE SIMPLE TITLEHOLDER: z-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,
1 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 conflicts with any.applicable Homeowners Association rules,bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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 1 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,
Signatu&dreontractor-or-Owner Builder as ap�ll'cable
STATE OF FLORIDA
COUNTY OF $r t wG1v _
Sworn to(or affirmed)and subscribed before me of _Physical Presence or Online Notarization
this —dayof- .AMMO' 202Zby
aeIr Mrbg tJNe,u.
Name of person making statement,
Personally Known�OR Produced Identification
Type of Idgentification Produced
(Signature of Notary Public-State of Florida)
Commission No. Sg 2-934PI� (Seal) ',AAu'�-0e, ANTHONY ALAN I y Pu
State of Florida-Notary Public
=* *= Commission 0 GG 233619
.�IFbF lIP � My Commission Expires
June 28, 2022
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DATE
RECEIVED
DATE
COMPLETED
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