HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r7 ? oq "Q,
Date: Permit Number: y'b J
Q �� RECEIVED
p I Building Permit Application
Planning and Development Services
MAR 16 7021
Building and Code Regulation Division Commercial ReSidenti-at'rgDapartment
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 7 7*7 J Lac cK . } 7S} L.ve-A e 3`1 9 R
Property Tax ID#: 3 "� - i- 0Q2 - 000 Lot No.
Site Plan Name: `, 11 Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
Alcui Sri C`y I"_ T'eey� Cp4j 6)r-1r5, Lk Aaer
New Electrical Meter V Second Electrical Meter
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: $ 1 O<:�O Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name V ' v Name:J�� �. C-1.�r cY-► �-
Address: 7 7 7 7 C x I �o1 MCA Company:
City: ?�- Sf_ L�C.-tC' State: Address: d1l
Zip Code: 3�y 7 Fax: City: G r-. state:
Phone No. Zip Code: Fax:
E-Mail: Phone No 5GI
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) State or County Lice se 2, 71-f r( �
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
de or an attorney before commencing work or recording our Notice of Comme ceme t.
Signature f b wner Lessee Co act o s Agent for Owner Si nature of C tractor/Li n of
STATE OF FLORI STATE OF FLORIDA
COUNTY OF COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
1L Physical Presence or Online Notarization V- Physical Presence or Online No arization
this_ day of /)')Liw'C�C., 2024 by this day of mt rck. , 2021 by
Name of peiison making statement. Name of person making statement.
Personally Known 9/— OR Produced Identification Personally Known_4 OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public-Stapp f Flori ARAD MOLINE (Signature of Notary Public-State of Florida )
"Ll m ion#GG16626T ry
Commission No. a ot�:.Uei, ARADMOLINE
oe ifesApril7,2022 Commission No. 2 . o (Se
Commisslon#GG 166267
FO01QBondTruBudgdNobNUYmsFF * 't
re$
FOf l ROAde I ThruBudget Notary 6ervice$
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Re-v-75/6/20
I Z a -.
k
EXEMPTION CERTIFICATE PARTS,OR ACCESSORIES
CERTAIN POWER FARM EQUIPMENT,REPAIRS,
ui ment,repairs,parts,or accessories described
below,
This is to certify that the power f�(date)from
urchascct of repaired on or a ( urchascd,repaired,
i (Selling Dealer's Business Name)is p
leSsed, ltccnse t.or rcnte+I for the following Purpose: production
ui meat for exclusive use in the agricultural
or irrigation equipment F.S.,
( } Dower fartrp equipmentraduced by those agricultural 'industries included in s. 5l0.02(1),
i
of crops or products.as p
or
r fa�rin equipment or irrigation equipment for exclusive use in agricultural
re prevention
ndustrries
( � power eq p or products,as produced by the
' stsppr�sion work for such crops
included in s. 570-02(l), F.S.,or
wer farm equipment or irrigation
Repai rs to,or parts and accessories for,qualifying po roduced by
eclr�ipmcnt for excl,u�s;ivc use in the agricultural production of crops or products,as p
those agricultural industries included in s. 570.02(1),F.S.,or
ewer faun equipment or irrigation
Repairs to, or parts and accessories for,qualifying P suppression work for such crops or
equipment for exclusive use in fire prevention and
pmdt;cis, as produced.by those agricultural industries included to S. 570.02(1), F.S•
l't"?WI:.R FARM EQUIPMENT: tr✓ �� I'
I understand that if I use the equipment for any purpose other than the ones stated above, I must pay
tax on the purchase or lease price of the taxable item directly to the Department of Revenue. I
understand that if 1 fraudulently issue this certificate to evade the payment
f sales tax
ct to ill be
liable for payment of the sales tax plus a penalty of 200%of the tax and
y J
conviction of a third-degree felony.
The exemption specified by the purchaser may be verified by calling 800-352-3671.
rajaser's Name: 'AA�� -
pup'jrQ1111ser'sAddress:--1--�-�--7 carl,f--�'O�j �-fl
iarrtc and Title of Purchawr's Authorized Representative:,
ADO �.
(Signature of Pur Cr o=Authorized Representative)
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