HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: a061'6 alc�3
91To IL l"J U C01'- RECEIVED
0 y JAN 13 2021
° a A ° ID p Building Permit Application
Permitting Department
Planning and Development Services St. Lucie County
Building and Code Regulation Division Commercial Residential IX
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
AddressA70S 1�(2�� tLa�E �� . , �� `- , '��i S A
Property Tax ID #: �� L� — O?) — o5 7) — CEO Lot No. Nz)c�
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
\� _e )tom v O
New Electrical Meter Second Electrical Meter
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 L.P Pitch
Total Sq. Ft of Construction: A Sq. Ft. of First Floor:
Cost of Construction: $ ?� I��,l n Utilities: —Sewer —Septic Building Height:
ER/LESSEE:
OWN'p
CONTRACTOR:
Name V
Name:
Company:
Address: Q,\$ Nw '\ x_%5' 8J2�%%P--2
City: State:��
Zip Code: 'J�-k`\ ti; ( a Fax:
Phone No C-7
Address: Q roy-9_ Pvv-�
State:
Zip Cod e:?:;WFax:
Phone No. 5s�'-1 S-C�\.
E-Mail: S� \�l -eta>roll\ ��'\�c�:.\ ����;
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-MailNG "�\C. C,N-C-'.1 •car
State or County License C`Ce-
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
Name:
Address:
City: State:
Zip: Phone
icable MORTGAGE COMPANY:
Name:
Address:
City:
FEE SIMPLE TITLE HOLDER:_ _ Not Applicable
Name:
Address:
City:
Zip: Phone:
Zip: Phone: -
Not Applicable
State:
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 your Notice of Commencement.
Si ature of Owner/ essee/Contractor as Agent for Owner
IlkSTATE
gnature of Contractor/License Holder
OF FLOI�IA
STATE OF FLORIDA
COUNTY OF 1--V
COUNTY OF S A.-zc0-_
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Prese ce or Online Notarization
this day of 7,54 V 202b by
this 3 day of 4'-- . 2024 by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Producorl Identification
Type of Identification
Type of Identific tio`n,
Produced C L -�
Produced
( ignzAure of No ary blic- State of Florida)
(Signature of Notary Public- State of Florida )
Commission KAREN S. ��� EN
"
Commissi "YPbB�, KAREN S. NIEL
��
:State of Florida -Notary Public
il
�a �s da-Notary u is
�• Commission # GG 207484
_• *= Commission # GG 207484
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Expim
une 12, 2022
REVIEWS
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REVIEW
REVIEW
REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20