HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: c'7 1 o;
RECEIVED
O �
MAY 2 9 2011
p ` ° Building Permit Application Fe n pepartment
Planning and Development Services St.Lucie Count"
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: G��'�' v i r> e�,
PROPOSED 1MPROVEIVI,ENT.LOCATI:ON -
s P II
Address:('Q 155 csV i - CA' 5
Property Tax ID#: 34[ 6 — D 06 — 00 1 _ (`100 p Lot No.
Site Plan Name: Block No.
Project Name:
DAILED DESCRIPTION
ET OF WORK,: fi N
k
0\/ _S l� I G2
L—tj 14
New Electrical Meter Second Electrical Meter
pCONSTRUCTION hNFORIVIAT]ON
Y J
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 d Roof 1 Z- Pitch
Total Sq. Ft of Construction: A0. Sq. Ft. of First Floor:
Cost of Construction:$ �, 5a� 0C) Utilities: —Sewer —Septic Building Height:
OWNEaR/LESSEE -° , "CONTRACTOR
Name c Name: ian � � n_9 V
Addre : 'C �' n' Compan L,�
City: aY+ '' LU r A.P-- Stater) Address: PP(0 la/1r1v
Zip Code:3 Lpoji5Z Fax: City:- -f �T Lipp �� State: It
Phone No ( Icy — ��5 Zip Coded l/) �1,5—2— Fax::
E-Mail: GLl 1.C6�'— Phon o
Fill in fee simple Title Holder o ext page(if different E-Ma V , am')rn p/Y
from the Owner listed above) State or County License
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 LA1Nf INFORMATIONS `,
r, r
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 or an attorney before commencing work or recording our Notice of Co mencement.
;��' <�V'4 9�L �'t
Signature Owner/Lessee C actor as gen for Owner Signature of Contractor/Li6errse Holder
STATE OF FLORIDA I � Q-r STATE OF FLORIDA r
COUNTY OF Sk. Ly � COUNTY OFL[AG
Sworn to(or affirmed)and sub ribed before me of CSworn to or affirmed)and subscribed before me of
Ph sical Presence or Online Notarization ical Presence or Online Notarization
this day of 202S by this ay of 2021� by
Al Q o ► 1�
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 P ced
F �y Pu to
(Signat a oNotary Pu li FI Lav a,et Signature of Notary Pu i - e'f GG
MY Commission GG 342376 ras 06106/2023
res 06=23 n/?
Commission No.`> e I lommission N l�
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev.5/6/20