HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED l
Date: blNi PermitNumberFo�5
RECEIVED
p MAY 1.4 2021
Building Permit Application
Permitting Departrnent
St.Lurie County
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 IMPROVEMEN411 OCATION
.. .., .
.Address: 311-7 Da its_ -erz-e, ifc' 3It' 5(6
-.PropertyTax ID# ..I... �. 7�Z�.C�.7t',G? .d:c' ..... . . ._ _._ ...` Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION'=0F WORK ;trrfl
1ectr a% 4,1AS1 1'og Aocyyl ..4V leckm dAf',k 44Az4'0 -_
�1�- nc�•�I p�- Co k_' TA 5-1 -J I CJA&?id a':!,
�►�dPr`�``�j► '���" 4-e In PeLS M Ski I( OwBnS CiPrn, ��1'iZg1 es !� `i►�i���
New.Electrical Meter -Second Electrical Meter
CONSTRUCTION INFORMATION
a ,
Additional work to be performed under this permit-check all that apply: -
_Mechanical _Gas Tank _Gas,Piping _Shutters _Windows/Door's, _Pond
Electric _Plumbing _Sprinklers _Generator Roof Pitch
Total Sq Ft of Construction: 000 Sq. Ft. of First Floor:
-Cost of Construction:$ i 2�Zsb Utilities: _Sewer _Septic Building Height: OO d<<
OWNER/LESSEE t "' CONTRACTOR
Name Name:
Address: ' i I'' U) C; li'd'u� Company: C_iSCA 5 RNb ;n� j-9Vct1 ,^y
City':,: ��. �;g;c;2 State: PL Address:
Zip Code:_3 Lf Cl Lf& Fax: H y-A C City: State: L
Phone.No. Zip Code:�n,cic( o Fax:
E-Mail: Phone No-772-Z7 Z.5IS /'77?429 467 i
Fill in fee simple Title Holder on next page(if different E-Mail C,l5&Cco;),iq reP4;E` 1 •C��M
from the Owner listed above) tate r County License�L I, �f
„'• 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.
1 ,
SUPPLEMENTAL CONSTRUCTION LIEN I_i4W IN,FORMATIO'N -
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 finaricin& consult
with lender or an attorneMetizire commencing work or recording our Notice of Commencement.: .
Signature of wher/ essee/Contrac or as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF I Uc-yw COUNTY OF
Swo to(or affirmed)and subscribed before me of Swor to(or affirmed)and subscribed before me of
Physical Presence or Online Notarization Physical Presence or Online Notarization
this 1 day of Y &.-, �92a by this 15
day of M Cc y 26�8•by
o
�harf h ca-�� e c� I s d v
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification - Type of Identification
Produced Fl• Ony,•ri's -Icvnst✓ Produced .L- Or/0'er3 4 J 6-eflS'e
F � 0_-
(Signature of Notary Public- at Flornl�d� Signature of Notary Public ti9 I,�lpf�ylPublic$late of rlonda
y o ar�Public$fate of Florida �J��r(C Hag\-rhorst
a �, Eileen C Hag�rhorst My COmmission,HH 019411
Commission No. �� bl9 P` g�er;,�mission,HH 019411 ommission No. D noaA Exp812024
or noF pees 07J08/2024 14 H O r
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