HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a\ Permit Number:
RECEIVED
`L L-UCE: _ JUN 01 2021
Building Permit Application Permitting Department
St.Lucie County
Planning and Development Services
Building and Code Regulation Division 'CorrlmerCial - ReSiderltial
2300.Virginia Avenue,Fart Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR:
PROPOSED.I.MP,ROVEMENT LOCATION ;
Address: 116a4Q �1Ce;c,���2.e 7C�-
PropertyTaxID#: a` "t„' '- ALia ` C7C� l 0Q01 _- Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION'OF WORK:
Tar CA \f-'zi-oc ctnA i4a_gll
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION: . .
Additional work to he performed .under this permit—check ali;that apply:
_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors _Pond
_Electric ,Plumbing _Sprinklers _Generator X Roof __- ,27 Pitch
Total Sq. Ft of Construction: lSGU Sq.Ft. of First Floor:
Cost of Construction:.$?, 00G Utilities: !Sewer _Septic - Building Height: 2 s�0 416
OWNER/LESSEE.-` CONTRACTQR
Name - C -r no k4. Name: YiGn.
Address: 1 f 6c1 Ea k¢.c.�rS�2a. lZ Company:�_kXt -(-L . C bcL5 O
State:Tj. Address: w4L
Zip.:Code-'_54 44 S Fax: City�y�!}_4 • Ly c4a, Stater
Phone No. Zip Code: 3ca9 S14 Fax:
E-Mail: Phone No 7 - 3 1'7`7
Fill in fee simple Title Holder on next page(if different E-Mail CJZoc�'�i
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.
a 7 .• r. w, w aMs is
DESIGNER ENGINEER: T Not Appiicable 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: 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,wails,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 attornev before commencing work or recording our Notice of Commencement.
Signature of Owner/ a /Co ractor as Agen for Owne Signature of Contractor/UiOH er
STATE OF FLORIDA / STATE OF FLORIDA
COUNTY OF L�c,�c COUNTY OF � �U -
Sworn to(or affirmed)and subscribed before m ofo o R. Sworn to(or affirmed)and subscribed before m 09.
Physical Presence or Online Notariz id] .z APhysical Presence or Online Notariz i& .
thisday of �?.qy 2020 by F:y this day of � ,2020 by $
o 0 g H.
Name of person making statement. w Name of person making statement.
�.
Personal)
° N' &
y Known _OR Produced Identifi tia�n-moo Personally Known i1� OR Produced Identiff tip Type of identification a c o Type of Identification to
Produced N N C Produced
(Signature of Notary Pub' State of a) (Signature of Notary(fmbfc-State lorida)
Commission No. drys 91 (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING i SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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