HomeMy WebLinkAboutCamScanner 05-06-2021 10.07SUPP.LEMENTAL'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
rvuuress: 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 Ipnripr or an attnrnpv hefnrp cnmmpncing work or recording vour Notice of Commencement.
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Signature of r/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder. _
STATE OF FLO IDA
STATE OF FLO A
COUNTY OF 1.1) CA12-
COUNTY OF We t.e
Sworn to (or affirmed) and subscribed before me of
Sworq to (or affirmed) and subscribed before me of
�hysical Pre nce or _ online Notarization
this � day of ��� 202t by
✓Physical Prese ce or Online Notarization
this,2„"Lday of , 2024 by
- 2
'tom. L UC-UMC, CCU.
Name of person making statement.
Name of person making statement.
OR Produced Identification /
Personally Known �R Produced Identification
Personally Known *
fide '
of Identifica n,
du
uce
DAISY 0.IVERA MCCLEL
_.��.r.�•....
Notary Public - State of Flori
a
✓r'd•. DAISY RIVERA MCCLELLAN
(Signature Notary Public- aF,, if� omm. Expires Mar 1<. 2
27( ignature of N ary Public- St t� - Gid 9 ary u ¢ • State o on
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Bonded through National Notary A
p Commission N GG 312148
sr. .ar Myy Comm. Expires Mar 11, tf
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Commission No. 121
mission No Bond('=@ Ih' National Notary A!
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/b/M
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
91T.
O
L3 _ 0000
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
1300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: AC CA0116C _ 00
PROPOSED IMPROVEMENT.LOCATION x,
ddress• 5100 u a ICIg DQ
PropertyTaxlD#: 6,40Z ,602 - 010q - 00o — S Lot No. .3-`�
Site Plan Name: Block No. y
Project Name:
New Electrical Meter Second Electrical Meter
CONSTRUCTION --
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: 02 Q /P Sq. Ft. of First Floor:
Cost of Construction: $ 94/00 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE ",`
CONTRACTOR
Name b0i6V vMpGele llaA)
Name: i"r OS
Address: 5/60 BOC40,70A
Company: &
City: A"B 1]•eeee. _State:
Zip Code: 3c1982 Fax:
Phone No. ��� - //8 - �P.Z �d
Address: AteO b'W C�e5L2ii� e
City: State:
Zip Code: 3V,3711 Fax:
Phone No 320- 545-'?i0(/1
E-Mail: dasy4DQex41eve/45•Nef
Fill In fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail EZV(c/D aC Q &2?0 /. e 0 i»
State or County License CAL - / ;� / 1 Gj$
i, value Ol....-ion Is zDw ar
If value of HAVC Is $7,500 or more, a RECORDED Notice of Commencement Is required.
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