HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `1�f
Date: _ '� I' Permit Number:
L, L��llL RECEIVED
Building Permit Application
Planning and Development Services St.Lucie County
Permitti�9
Building and Code Regulation Division Commercial X Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR: M p �'4 0 pt -5 1 r
PROPOSED IMPROVEMENT LOCATION:
Address: i05QS h 00-f-A " Me . —A?a 67!- . 3 7
Property Tax ID#: z1$l/� �Dl7- D00 4�- OOD ' a _ Lot No.
Site Plan Name: Block No.
Project Name: 'axA,4 d
F6TA-I—LED DESCRIPTION OF WORK: J
U.,:) I i-1-v HI 0 A-►-w> r4&-10 OAW-%J 0 0*Or fb
New Electrical Meter Second Electrical Meter- (Affidavit required)
CONSTRUCTION INFORMATION:
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 Roof Pitch
Total Sq. Ft of Construction: �5_3 7s Sq. Ft. of First Floor:
Cost of Construction: $ c9 , 700.60 Utilities: _Sewer — Septic Building Height:
( OWNER/LESSEE: CONTRACTOR:
Name R fOe46 FgD-J A►4 sO A.l ►[-f�LY� Name: c-h V-
Address: 5 004.4AJ Company: i,:�LAA4,0 Cs..o-j
City: J150540 Aosoe4w State: ;F�. Address: 4I.4 S v114 Xbt9
Zip Code: 46 7 Fax: City: W State: f-�c
Phone No. 72d- oV l- /90;Z E- Zip Code: 3`f 7 Fax:
Mail: 4, ] 4fOdvr t�,4 ,►U -l; Phone No "7a a�1� - 0--7 0>77
Fill in fee simple Title Holder on next page (if different E-Mail f'G�J�,l�c�CaD'S�6J5 GHL. LD ✓1
from the Owner listed above) State or County License9':� IotM if
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 I MORTGAGE COMPANY: _ Not Applicable
Name: 0Xd tonA, 7 G,a GG4-g:X Name:
Address: iapp W!L,=W Address:
City: '3'POA State: r . City: State:
Zip: 33ti32 Phone 661 ayd • 3113, Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: a6,25-tDo a a oz, e.UG Name:
Address: /o a4— 3 ee _ Address:
City: fc,96,� Vadcesl 9:'-t City: -
Zip: 3 y4,9'7 Phone: -77a - 62D/- /a D 2. 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 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 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
WARNI NG TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
im o your property. A Notice of Commencement must be recorded in the public records of St.
ucie County and p ed on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or n pa for V before commencing work or recording your Notice of Commencement.
fir
sign -or-Owner Builder^applicable
STATE OF FLORIDA
COUNTY OF *4 A- 7 //-r
Sworn to(or affirmed)and subscribed before me of L4hysical Presence or Online Notarization
this I b day of.,reAA-u n4of , 20 U by
Name of person making statement.
Personally Known r/ OR Produced Identification
Type of Identification Produced ,I ✓4�1 'S
4
(Sign Lure of Notary Public-State of Florida)
Commission No. oyla2 ou (Seal) �4M Notary Public State of Florida
Robert M Rice
My Commission HH 103595
�ly�ri Expires 04/03/2025
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE 1
RECEIVED
DATE f
COMPLETED -F
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