HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 0456
Date: •a\ Permit Number:
. 1
RECEIVED
1 .a o > o taa MAR 15 2021
Building Permit Application
Permittl Department
Planning and Development Services S`, uae Doubt•
Building and Code Regulation Division Commercial Residential L
2300 Virginia Avenue, Fort Pierce FL 34982
4'
Phone: (772)462-1553 Fax: (772)462-1578
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PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION"' .
Address: ��?lr'�� a/ AC-2, t>
Property Tax ID#: '�� Y�� ��(c " �J �%� Lot Noj
Site Plan Name: ��i+-t� ?�:��C C�ci' p'- �=i`�' ��= j t_�� Block No.
Project Name:
DETAILED DESCRIPTION,-OF WORK:
New Electrical Meter Second Electrical Meter
CON5TRUCTION`,INFOR�MATION ,
Additional work to be performed under this permit-check all that apply:
.a,
_Mechanical _Gas Tank —Gas Piping _Shutters _Window /Doors _Pond
_Electric _Plumbing _Sprin lers _Generator Roof � (�— Pitch
Total Sq. Ft of Construction: -Z paw Sq. Ft, of First Floor:
Cost of Construction: $ Utilities: _Sewer Septic Building Height:
OWNER/LESSEE: C_ONTRACI )R:.
Name ] r"P� h.s .� -�'"' Name:
Address: 4XG_r- �4� : �� S'i:, Company: _ % L
City:-k V V-G-C, State:VL— Address: CAvf2 _
Zip Code:—:!5A`3 5 Fax: City: State:-Y! u—
Phone No. Zip Code'3gC'l0t 0 Fax:
E-Mail: Phone No �'�'/ p-A91 -
Fill in fee simple Title Holder on next page(if different E-Mail '-7 t-A
from the Owner listed above) State or County License r '_C_�?7'7 f kaL,�
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 regr,_rsd.
SUPPLEMENTAL.CONSTRUCTIONJI TEN .LAWINFORMATION;:,
<< DESIGNER/ENGINEER: _No_-: ,pplicable 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'i- ;ranting a permit will authorize the permit holder to build the subject structure
IrI which is in conflict with any applicable Home Ou' iers Association rules,bylaws or and covenants that may restrict or prohibit such
ti structure. Please consult with your Home Owne: 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 your Notice of Commencement.
TSinature of Owner/Lessee/Contractor as A ent for Owner Signature o Contracto /Lice se Holder
STATE OF FLORIDA STATE OF FLORIDA l
{r COUNTY OF COUNTY OF
h" S�n to(or affirmed)and subscribed before nee of Sw_ 1,to(or affirmed)and subscribed before me of
P ysical Presence or Online Notarization V Physical PiresM or Online Notarization
this day of 202� by this�'�day of Y 202p by
IRM
Name of pers n making stateme t. Name of person aking tatement.
Y
Personal) Known ✓ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
tZ
(Signs ure of Notary Public-State of Florida (Si attuMr%1of Not�,r S SEN
e�=State of Florida-Notary Publi
Com i��" KAREN S. NIELSE[,fi Commission # nn ¢ al)
ea Co 207484`
�SSE61C OF FluddaOtary Public ��FOFfI�P lvly ommission Expires
a *= Commission # GG 207484 ""'"� June 12, 2022
�I i 9f
June 12 2022
RE SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5