HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 6)1 l tt -a Da Permit Number: ► >in 1 �.
RECEIVED
p� R� JAP9 5 .2021
L� � c ` � u r Building Permit Application
�@rmitting Department
St. Lucie County
Planning and Development Services
Building and Code Regulation Division Commercial Residential V
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
I
PROPOSED IMPROU:EMENT LOCATIQN x ,.
Address: 1051 8r_1:7' f_1/ S • Rt/`ccl , 39��
Property Tax ID#: 311 OZ — 6 0 F— 0-1 03—000-3 Lot No. I
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK.
v-U' exi6�}in
I
i
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 I Pitch
Total Sq. Ft of Construction: a , 18 Sq. Ft. of First Floor: 10 S
I
Cost of Construction: $ 700 Utilities: —Sewer —Septic Building Height:
OWNER/LESSE}E r CON1 RACTOR
Name Rc,,AI I Po Name:
Address: ID31 (btJ1S'_ �' Company:
City: rn/ pc "e, State: rL Address:
Zip Code: 3` 16a Fax: City: State:
Phone No. �$���5� Zip Code: Fax: I
E-Mail: Phone No
Fill in fee simple Title Holder on.next page(if different E-Mail
from the Owner listed above) 'State' or County License
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 IN.FQRMATION.
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: A.cldre-ss.:
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 th,e 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, I
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.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
,_A
COUNTY OF COUNTY OF
S�to(or affirmed) and subscribed before me of Sworn to(or affirmed) and subscribed before me of
P�,Ys"ical Pre e or Online Notarization Physical Presence or Online Notarization
this ; day of 42o 29-M-by CP . this day of 2020 by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of IdentiftcqYn - Type of Identification
Produced // i 1/ Produced
(Signature of Not Ur Public-State of Florida (Signature of Notary Public-State of Florida )
t�ava�aG,, UD�CY B.HUMPHREY
Coin mission No. =°'
M ��1:(91SSION#GG300817 ommission No. (Seal')
EXPIRES:March 6,2023
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2