HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED O�
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Date: Permit Number: L O
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lGc90 ��
Building Permit Applicati^eP��
Planning and Development Services �` u
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
PRQPt?SED IIU,PRC1UEIUIEVT,LQCATION
` , / :
Address: Cv F �l�C
Property Tax ID#: 33� a- ��biV Lot No.
Site Plan Name: /� Block No.
Project Name: Mc-co eny
DETAILED DESCRIPTION {JF WORKS
Flu j .� �� L� �c_Qcc 3U ®v e_a_ E
CAN C2.04� S LA e
New Electrical Meter Second Electrical Meter
Ct7NSTRUCTION IIUF0 MATION
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: LZ9).!� Sq. Ft. of First Floor:
Cost of Construction: $ 1 ,Doe) •cro Utilities: —Sewer —Septic Building Height:
OtIVNERjLESSEE. 4Y �g r , CONTRACTOR. ,
Name Name: �f�d\71C floe
Address:7(e!)SGs NV-, Company: r:�DOZAC V- Q-AS t. LLL
City: pSL State: rL- Address: t 7`!. ( S W -,kM 0e&SCYV-\ S --r
Zip Code: Z y 18 (o Fax: City: (>5 (-- State: ��--
Phone No. ` 7 7 2.+ Zl(a"' 2,��-� Zip Code: 7> ICJ. � Fax: K
E-Mail: Phone No -7-7 2�`5_3 d zce ®,�;-
Fill in fee simple Title Holder on next page (if different E-Mail JC_1 _ '50 0`�_k I n c`-t
from the Owner listed above) State or County License C,�-- G 02 4 (o �- (a
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.
SUAPLEl1lIENTALCONSTRUCTION LIEN LAW iNFORIVlATION
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: /1 State: City: State:
Zip: 'Ph ne / I Zip: Ph ne: i
I
FEE SIMPLE TITLE HOL _Not Applicable BONDING COMPANY: Not Applicable
Name: TName: X/
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 ouM and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lendlpr cJr an attorney before commencing work or recordin our Notice of Commencement.
Si ture of O 2eressee/Contractor as Agent for Owner Sig ature oontrac r/License Holder
STATE OFLA STATE FLO A
COUNTY OF k COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presence or Online No arization Physical Presence or Online Notarization
�2 ay of �
this T , 2021 by this day of =p"'t 2021 by
L- �) - CGC-
Name of person maki g s teme Na a of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identifcatio Type of Identification
Produced ` LX Produced
rA
(Signature of N qjj�M crry PubI ( ' r�y� is �lo a )
\\YIPUB, of Florida- 270079 \\\Y P��,, Pu Iw
1oS State GG tiP e
Commission No. __° Cornm�5gion# Xp�res :o a ��;State of Florida-Wary79
�omrri,� �2? C _N IIc�ommission # GG 2 Aires (Seal)
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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