HomeMy WebLinkAboutBuilding Permit Application AEI APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12 0$ - 0 Permit Number:
RECEIVED
Building Permit Application JAN 2-0 2021
Planning and Development Services Permitting Department
Building and Code Regulation Division Commercial Residential St- Lucie County
2300 Virginia'Avenue, Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
PRb Ib z`x•
Address: g96-0 S Ore!'Ailu U_-i T&_—iystF" 15a-i4c4 FL 34-?S7
' Property Tax ID �°Jd�•-�d3- �oa-��a- 1 Lot No.
Site Plan Name: M l �iA A oOt7+R ROL(J4Lt_ C0tV]20A41A11(,efi4 Block No.
Project Name: - /00® 01A— L PL G®ND17"l oty 1mg
DE,TAaIL'ED DiE-SGR�I°PTLONF OaF-WO'RhK;_
_
Ar—T � /d�C �r.
New Electrical Meter Second Electrical Meter
C,01NS�F°R�UCTI! NCaINFO'RI1%IA
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: Sq. Ft. of First Floor:
Cost of Construction: $ 7. ®® Utilities: —Sewer —Septic Building Height:
OWMIERr/L'ESSE,E° CO`NTR�ACzhw
a OR
Name Name: 04q LOp EZ 3uC`710-/a2,G�f
Add ress:!955G'S� Company: ® ® j
City: state; ' Address• -7/6!7 SW 42 7V�g/2
Zip Code: Fax
• • ��.y���' City:_mil B a4o14% State:,.,
Ph Zip Code: 3:S/;S'$" Fax:
E-Mail: d �L 'o ' //L ww Phone No .5`-�® �- 777
Fill in fee simple Title Holder on next page(if different, ��j '7
E-Mail_ %2FMP7M&1_A.e-Co41
from the Owner listed above) State or County License1�
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.
SUPPLE;MENTA'L C0'NSTR',U'CT10N :LfEN",LAW,I;NFa'R'IVIATfOjN
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: PhoP6 Zip: one:
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 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 our Notice of Commencement.
re Si nature of Own r/Lessee/Contr s" ent for Ofivner Signatur of Nptrado /Li a Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF \ _ COUNTY 1 't'�4 I° 0A-0%Z
Savor o(or affirmed)and subscribed before me of Swor (or affirmed)and subscribed before me of
Physical Presence or Online Notarization W Physical Presenj:�or Online Notarization
this/4 'day of '�,�i�� ,202Jd by this [+day of -%11 207d by
P
4FL
Name of person making statement. Name of 66rson making state ent.
Personally Known OR Produced Identification Personally Known / C@e�tab p ii—
Type of Identi ation Type of Identific tion P WtLL MISS1pN#GG21
Produced f i [_- Produced "' �`° Y coM tnbet IS,2o22
(Si ature of hlotary Pub ic-S�te of Florida) (Si ture of N rji Public-State of o ' a)
^�� WILL�AIA T.ILLY --
Commission No. �� ° SP al]
MYC�MT�ileON#GG277615. Commission No. (Seal)
EXPIRES:November18,2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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