HomeMy WebLinkAboutBuilding Permit ApplicationV
All APPLICABLE INFO MUST BE COMPL E, aNq%j1Wj'T4dA%C_wCEPTED
Date: Permit Number: � . ` VbS'!�
91T. [Lon
o.
Bt
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
RECEIVED
APR 2 8 7071
ding Permit Application R?rmiWng Department
St. L clC unty
Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED IMPROUEMENT'.LOCATION ;:,_
Address: (0 0 S 44Wu► FT- f i �1 4,
Property Tax ID #: d - G ^ 1 f 0002 Lot No.
Site Plan Name: Block No.
Project Name: Porch 0A.4-cln
DETAILED DESCRIPTION OFWORK:�, ,
�e.m
ah'
New Electrical Meter Second Electrical Meter
CONSTRUCTIQN INFORMATION: :
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank Gas Piping _ Shutters *VWindows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers _ Generator k Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ �2%S . d!I Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE::
,
CONTRACTOR'
Name &Wn.ND_Wo
Name: 5I a kic Cam &Vit(, 6, !a
Address:%AQ?, S TWI' 1 OJef by-
Company:
City: ET. P l ft C G State: ft-
Address: W f ,S A adt_ c.�
Zip Code:U. Fax:
City:Qeo kA(k, Stater
Phone No.
Zip Code: SM0 Fax:
E-Mail:
Phone No]" -766 - %YYZ_
Fill in fee simple Title Holder on next page (if different
E-Mailer n 10S 4rye 6m 4&4 a R-Ca"
from the Owner listed above)
o u c f�,'"�.t o
If value of construction is 2500 or more, a RECORDED Notice of Commencement is requwrea.
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: _ 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:
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 tvileelgir
improvements to your property. A Notice of Commencement must be recorded in t c records of St.
Lucie County and posted on the jobsite before the first inspection. I tend t financing, consult
with Ipndpr nr an attnrnpv hpfnrp cnmmpncinE work or recor ' e v Notice mencement_
%
I
S natur caner/ L ntractor as Agent for Owner
UrIcf Co ctor/License Holder
STATE OF FLORID
� L
STATE OF FLORID
COUNTY OF L
COUNTY OF -
S or to (or affirmed) and subscribed before me of
Physical Presence or Online N tarization
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this ,21!� day of , 202J by
this aE,day of Z% 2020- by
BR JA-,u
DILLaz,) S1 EE(Z
Name of person making statement.
Name of person making statement.
Personally Known _X OR Produced Identification
Personally Known X_ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
1
gnature of Not Public- State
BONNIE L. KRAM
ature of Notary Public- Sta o • , ors, a
; t am a� SONNIE L. KRAMER
Notary Public— State of
Commission No Commission # GG 16
' 2 �- Notary Public — State of Flod
lopdanl ission No. 0 : �` * ($eaf)mmission # GG 16726
205�
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- r : My Comm. Expires Dec
1 �2021 My Comm. Expires Dec 11,.
�cF?` a• Bonded thro National Not
A Bondeftrou Natonal N
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ZONING
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VEGETATION
SEA TURTLE
MANGROVE
SUPERVISOR
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DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20