HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2 -25 2- o2-1 Permit Number: �•�by' da�o�
RECEIVED
94° L UC E APR 0 8 2021
p. O �.... ' .Y�- .
Building Permit Application (�rSt. Luc Deounty -apartment
5t. Lucie 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: New m(f, build
PROPOSED IMPROVEMENT LOCATION:
Address: "I S 49 Germony Canal kd Po,-+ S--- Lucie , FL 3yg8rl
PropertyTax ID #: 322-9 --1-41 - 0001- 000- 0 Lot No.
Site Plan Name: VQ�/ Resiae-nce. Block No.
Project Name: sad/ R &-side-mc-,
DETAILED DESCRIPTION OF WORK:
(, o ns-+ruc-H on
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical X Gas Tank X Gas Piping _ Shutters Windows/Doors _Pond
Electric Plumbing _Sprinklers _Generator Roof F /2- Pitch
Total Sq. Ft of Construction: % Y 0(p ' )Sq. Ft. of First, Floor: �i, q() ce
Cost of Construction: $ --� EO . 000 Utilities: —Sewer Y Septic Building Height: 21 0 q y8 �
OWNER/LESSEE:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical X Gas Tank X Gas Piping _ Shutters Windows/Doors _Pond
Electric Plumbing _Sprinklers _Generator Roof F /2- Pitch
Total Sq. Ft of Construction: % Y 0(p ' )Sq. Ft. of First, Floor: �i, q() ce
Cost of Construction: $ --� EO . 000 Utilities: —Sewer Y Septic Building Height: 21 0 q y8 �
OWNER/LESSEE:
CONTRACTOR:
Name a n Ol
Name:
Address: -7 N)N 2r'ctlCbcd Lane,
City: POr+ 5 4- • Luue- State: FL
Company:
Address:
Zip Code: 34 q 93 Fax: W
City: State
Phone No.-112.-3-10-311 q
Zip Code: Fax'
E-mail: 9-rdoc -02-0 ama[l cam
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail
State or County License
from the Owner listed above)
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 IP
DESIGNER/ENGINEER: Not Applicable
Name: FIL DeS1gn bw'1J_ ln5f2e c_+
Address:
City: State:
Zip: Phone -1-12-321-45 oo
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
ORMATION:
MORTGAGE COMPANY: _/Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: [Not Applicable
Name:
Address:
City:
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, l 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 an attaf�ey before commencing work or recording your Notice of Commencement.
AgEture
of Owner/ essee/Contractor as Agent for Owner
Signature of Contractor/License Holder
;IDA
t
STATE OF FL
STATE OF FLORIDA
COUNTY OF �-13� •�e
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Presence or _ Online Notarization
thisp- -L day of 202Q by
this day of 2020 by
h� dy1 �dy
Name df person makin statement.
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 P lic- State of Florida
ignature of Notary Public- State of Florida )
.� l`W�� DEANNAGIVENS
Commission No. '�'3 ;{Seiiry public • State of Ron
HH 086359
t mission No. (Seal)
�� Commission #
"Comm. Expires Jan 28, 2
25
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Bonded t
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