Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
HomeMy WebLinkAbout6603 Pensacola Rd permitAll APPU LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 Permit Number:
0
V Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierre Ft 34992
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:R �C
PROPOSED IMPROVEMENT LOCATION:
Address: N
�Q j
A �' "" C S `
Property Tax ID #: ! I Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
FL A64';4 ,1 un-o> J SLt1 f } W
New Electrical Meter Second Electrical Meter (Affidavit required)
[CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
_Mechanical _
_ Electric _ Plumbing _ Sprinklers _ Generator Roof - 1 s=— Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: _Sewer Septic Building Height: �� d
WNERAESSEE:
CONTRACTOR:
me1 f"IIS5�� )') 11E
r
Name: i
I .Le,dress:
Company: lyl`t I Q�
�0�0(` �� ��C R (�. 5���5 +
Addr " S
City: Eo,'�TrC-e, State: (
Zip Code: Fax:
City: - H State: EL
Phone No. - `�~%' 1 J� E-
Zip Code-�� �aoZ Fax:
Maili� �
Phone No 1
Fill in fee simple Title Holder on a (ifSf uwd
E-Mail e
State or County license C'
from the Owner listed above)
If value of construction is 25M or more, a RECORDED Notice of is required•
If value of HAVC is $7,5W or more, a RECORDED Notice of is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
city'
State:
City. State:
Zip: Phone
Zip: Phone. -
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
name:
Address:
Address:
City:
City:
Zip: Phone:
Tip: 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 represe�nbtion that is nting a permit will authorize the permit holder to build the subject structure
which conflicts with amapplicable .cable Homeowners Associa�ion rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult wrath 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 structure, 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 toViry
operty. A Notice of Commencement must be recorded in the public records of St.
Lucie County a on the ' e before the first inspection. If you intend to obtain financing, consult
with len c mencing work or recording our Notice of Commencement.
of Owner/ L tractor as Agent for Owner
STATE OF FLORIDA (
��C,�
COUNTY OF C;� R
Swom to (or affirmed) and subscribed before me of V Physica€ Presence or Online Notarization
this = day of 20,.V by
Name of person making statement. ..
Personally Known OR Produc Ident�catio n
Type of Identification Produ
CEL=
(Signature of Notary Public- State of F oriel )
Commission No. (seal) ADRIANA RASA
Wiry NODC • State or Flenca
Cmrnnsw 0 GG 44625
t
My Cmm. Spires � 1. 2021
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/2I