HomeMy WebLinkAboutBuilding Permit Application All APPLI BLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � 1 a l RECEIVEDFr� Permit Numb ii' 41
rc^-� ` r�r�r�!rr-rttt JUN 0 1 2021
vc ` L— Permitting Department
St.Lucie County
Building Permit Application ECENEp
Planning and Development Services
�1 2021
Building and Code Regulation Division Commercial Residential r
2300 Virginia Avenue,Fort Pierce FL 34982Ifi� ► �AfIE
Phone:(772)462-1553 Fax:(772)462-1578 St.Lucie County
PERMIT APPLICATION FOR: 60 CA Q
;,P�G?PQ��D,�,MPRflVEME,N.T�aCa�IE�N; ;�
Address: .,r_-ii0_7Q4 Tel" !D i nex c.r c c.l
Property Tax ID#;. 1!31,. "" 099 003a. `" 000 — Lot No. -21,
Site Plan Name: Block No.
i
Project Name:
DEl'AI.LED Di.�CR PTifl3 . WORK=;
Q,o►r 4 i i n n c1
rn c& ainAl , cz
New Electrical Meter Second Electrical Meter
=CONSTRL�CT10111,I,�vFaRMATION� ...
Additional work to be performed under this permit—check all that apply:
Mechanical _Gas Tank _,Gas Piping __Shutters Windows/Doors Pond
Electric r Plumbing _Sprinklers !Generator X Roof Pitch
Total Sq.Ft of Construction: .&Mg3 Sq.Ft.of First Floor:
Cost of Construction:$ /�ACx) Utilities: Sewer ! Septic Building Weight:
i
.6 VW'Ek/L ssE� caruTr;A rO�,
Name Name: �Ckn
i Address: a CSQ CompanyT ^e,e1SUC
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City: State:5_'_L Address: MNm&
Zip Code; 419 t Fax: City. OC`� State L
Phone No. "?101 /0750 Zip Gode:3t�Ci Q,44 Fax:
E-Mail: Phone No 1 Za-- ,a.. C)in o
Fill in fee simple Title Holder on next page(if different I E-Mai GA C..GCQ2.. •CA
from the Owner listed above) State or County License C. e
If value of construction is 2500'or more,a RECORDED Notice of Commencement is required.
if value of HAVC Is$7,S00 or more,a RECORDED Notice of Commencement Is required,
V
I Vol
10-0-
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DESIGNER ENGINEER: —Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City:. State;
Zip: Phone _ _- Zip: Phone:
FEE SIMPLE TITLEHOLDER: ____Not Applicable BONDING COMPANY: Not Applicable
Name: dame:
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 4r artd covenants that may re tract or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions whicA 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 Commencement.
Signature of Owner/ esse /C r for as Agent for Owner Signature of C ntr t /Li nse Holder
STATE OF FLORI STATE OF FLORIDA
COUNTY OF S^r_ LUGe' COUNTY OF_
Sworn to(or affirmed)and subscribed befor me of Sworn to(or affirmed)and subscribed before me of
b" P ysitai Presence or Online Not ization �Physical Present or Online Notariza
this day of d. 204 y this,2i day of 2020 by
—2cla& AA
i Name of person making stater6ent. o c Z Name of person making statement.
9 m Z
Personally Known !f- OR Produced Idea ti CM Personally Known �' OR Produced Identifi ate o
Type of Identification 91 r a Type of Identification �
Produc d Produced 3 3'
G) _
.0 �o98
n
ignature of Notary Public State of orlda v J6/ Z M
o (Signature of Notary Public--State o lorida} o
Commission No `9 (Se } c d Commission N A741!;L (Seal
N f�D-"�•
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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