HomeMy WebLinkAboutBuilding Permit Application •'l
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ,-/>-A / Permit Number: 10 r
RECEIVED
MAY 2 4 2021
Building Permit Application
Planning and Development Services Permitting De a ent,
Building and Code Regulation Division Commercial ReSidentiJI Lude ntv
2300 Virginia Avenue,Fort Pierce FL-34982
Phone:_(772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR
Address: �4 8CASA R`tD
Property Tax ID#: 0 X- 00
Lot No.
Site Plan Name: Block No.
Project Name:
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DETAILED DSCIlPTI01V®FUUORK Xr r �, `
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2 ;? .C. �OQL94AL 7k& UWI
New Electrical Meter Second Electrical Meter
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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:$—E' J��G Utilities: _Sewer _Septic Building Height:
��E-R�LESSE� 5.P 3 -
Nam`e C o Name l� -
Address: S D Company
City 'f f S>` Zr/c1 State: G Addr
Zip�Code .,� Fax: city: (X --4 t• State:�L
Phone.No.' Zip Code:--, Wg53, Fax:' 3�19�423
E-Mail: Phone No 77,1 `P-Q��P�Q
Fill in fee simple Title Holder on next page(if different E-Maili�(i�l
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. 5
i
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.
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 lerAer or an attorWy before commencing work'or recor our Noti of-Commencement:
Signatur of Owner/Lessee/Co ctor as Agent for Owner Sign ure of Contractor/Licen5o,,Rolder
STATE OF COUNTY OF
STATE OF LAG[C COUNTY OF
LLJC t P_
Sworn (or affirmed)and subscribed before me of Sworsrto(or affirmed)and subscribed before me of
',"Ph sicaI Presence or Online Notarization ✓Ph sicaI Presenc or Online Notarization
this�day of 2021 by this 2 day of 202P by
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Awwle
Name of.person making statemeLd Name of person making statement
Personally Known ✓/OR Produced Identification Personally Known' ,---OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public Stata'k9f� Iorida�AROLA WEAGLE (Signature of Notary Public- to of r
/+rp Commission#GG 1953M1 � * f~ *, Commission#GG 1
91321
Commission No.Gw=` l5 (Sepin3sApril 5,2022 Commission No.GV 17 5 3 3 �'�,Fa !aI sApiil5,20
Ii'OFF�oPA BondedTlwBudCMNotarysenicea 17uuBudgetNotery-
REVIEWS FRONT. ZONING_ ' SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW -REVIEW
DATE
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COMPLETED
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