HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: - c% Permit Number: 'c;\0O
JAN 2 0 2021
... rmitting Department
® St. Lucie County
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR- 'A,nae�I
Residential
Address: -VA NL&*Le-S VAvy ek �3495`?
Property Tax lD #: 4564 -'50l - 61� 4 % - 006 dS Lot No.
Site Plan Name: Block No.
Project Name: 751-
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New Electrical Meter Second Electrical Meter
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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: 16o Sj
C,
Cost of Construction: $ \ -700 d
Name Goa-16 W
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
Address: I (PI Ngkkte.- G1vr)
City: J ion ->e-Nn 102>� State:
Zip Code: 341 S Fax:
Phone No. 77 a - (:�440 - �A Wc!
E-Mail: JAY3-%Gf-e.0—Vr IP ggbeL%1-0014
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: �G4n�cs
Company: C 'I L Gah�s
Address: 3I'S1 Se 5\-Ae( S4
City: j` Q Rl< . State: qrl.
Zip Code: �y �� ") Fax:
Phone No SS;yo
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State or County License_ � 6 G C�
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.
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DESIGNERLENGINEER: _
Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name: 1GYVC'fA
Name:
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Address:
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State:
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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 attigp4ey before commencing work or recording vour Notice�Commen cement.
Sign atu rq&OGner/ Les ntractor as Agent for Owner Sign Contiactor/License Holder
STATE OF FLORIDA I STATE OF FLORID/ / ,
COUNTY OF Sk- _ L��� COUNTY C uyha
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this-�,6 dayof"JGY\ .2021 by
C1a.i araiN '�' IAa��S
Name of person making statement.
Personally Known OR Produced Identification
Type of Identific ion L_
Produced
i
(Signature f,ublicC$W€e!`bii@g�J�
:State of Florida -Notary Public
*= Commisslon # G �gyg
Commissi a4s
o, isslon Expires
C)ct0btar 22, 2022
REVIEWS I FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Sworn_toor affirmed) and subscribed before me of
hysical Presence or Online Notarization
this oNay of 7TOncux -k= by
_J" 2oZa
Name o pe son making st/atement.
Personally Known '�_ OR Produced Identification
Type of Identifcat* I
Produced'-�
F Notary P-ublitt-St rayot3iy Public - State of FI
Commission # GG 965&;
No. Cp{nm. Expires Mar 4,
� hyd
Bon ugh National Notary
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