HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: AAWN 2 I 2-1 Permit Number: "0(°Glt
RECEIVED
00 ]AN 2.9 2021
71
,F. 'L W(eR T4 b 'A
Building Permit Application PefSt��LucieCountyent
Planning and Development Services
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:.
PROPOSED IMPROVEMENT LOCATION: ,p
Address: g�� S• �G � Qom.• UJu 1�' T -I'� ��
Property Tax ID#: �S�j5 — Go ( " O lb Z O00 " Z. Lot No.
Site Plan Name: -T-46 LC';,YVl 12A L_ Z f_sL As y> D w ES Copt* A • Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
yCMD l l'�'1DdJ ►tom �2>'EpAQ-0tT�a N rro'2 '2�No�/k'r'tallJ, S� �TTAcI'1ED� ING•
aJE ��uJ�(� I►.�SP��inEy Asa ��� IUoN-t�k��1G G1Alls . ��w�cu� �Ine2CeJEt�cJcs
�J� �a1NG '(�P�-DabP-�,�-+�b�a•�+�6s(��rEs:.i�a..nN�►� ��_S�N�+S �(Ers,�'f�b
New Electrical Meter Second Electrical Meter-T dg,? Ali � pP�r:C� 0 1�RaAcNs
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 Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ -7DiD(Q Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Ckt�� Name:
Address:�?5=D S•OC1G1kafJ 172 F -49 f Company: o pG�,,c,�(3ca�'�t ��,�Tia�tcrzs�
City: J>✓�S� Vcs -C State: i�L Address: 6TQ-55W &-tA WA`t'•
Zip Code: 1 �! Fax:�1 City: f t_L,04 DA Stater
Phone No. /��, � r ' S I Zip Code: :g 'r7 l I-- Fax:
E-Mail: Jjtt-2e 7b�8 aMAi L •Cant Phone No ??2 - 240 -
Fill in fee simple Title Holder on next page(if different E-Mail117C!;i C-.0 ®M'15-- •CpM.
from the Owner listed above) State or County License C&( 12S07b Z.
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 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 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.
Sign re wner/Lessee/Contractor as Agent for Owner Signature o ont ctor/License Holder
STATE OF FLORIDA- _ STATE OF FLORIDA Q
COUNTY OF 1`J� wa� COUNTY OFn'
Sworn to(or affirmed)and subscribed before me of SwW .n to (or affirmed)and subscribed before me of
r/ Physical Presence or Online Notarization P y lcal Presence or Online Notarization
this day of t 7 car,uoiflA 2e2&by this day of�TGn r✓o�rv� 2e2e by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of ldentifca 'on Type of Identificatio
Produced )' �-- Produced
(Signature(Signature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florid
.tN+ ......, SAZExpiresAug
• SANDRAVGGtt�� �I No�a�� Florida Commission No Public-Statlo�Fio?idd Commission No. ;<<;-:
•; : = Commi9530
'� ' •'< Commission N GG 139530 =;�•,G r ,;;= My Comm. 9,2021M Comm. Ifandedlhr taryAssn,rUund dlhrouyhNalionalNolvyA sn.REVIEWS O ERVISOR PLANS VEGETATION ROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED '
DATE
COMPLETED
ev. 6 0