HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: l9• 7 Permit Number: I
RECEIVED
4P6494
JUN 0 4 -2021
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Building Permit Application PerSt.Lug Counme�
Planning and Development Services St.Lucle 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:
Address: ��OS 6ir/,� GIP V .
Property Tax ID#: 9 2 C1 '��2. -0 "93-L - /VP - 0 Lot No.
Site Plan Name: Block No.
Project Name:
10�AMEN/R
ESCi �Pli� �-
aa_ Mier � e( v Q/
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:
()U . 00
Cost of Construction:$ Utilities: _Sewer _Septic Building Height:
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Name Lcu4rA L 74ro, /d NameXpi/th IS 1i I 1A
Address:_��o(�5 S7f. LGLi BI/d GIAr�``Z� Company: revl�C ,914A �h
City: FL"r+ Fie State: F�L Address: FAL her
Zip Code: 349 4(D Fax: City:F0 f i~- (8(t"{, state: FL
Phone No. 177- 341 —43 39 Zip Code: 34 5_0 Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail '• �(!�/I/1
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.
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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 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 f ancing,consult
with lender or an atWrney bef re commencing work or recgrdin our Notice omCne ement.
Signature of Owner/Lessee/Co actor as Agent for Owner Signature of Contractor/License Ho r
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
SworD to(or affirmed)and subscribed before me of S n to(or affirmed)and subscribed before me of
_✓P sical Pres a or Online Notarization P ysical Pre a or Online Notarization
this day of ?1320'by � ) this day of Jp2�by.
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Name of person making statem Name 07 person maA'jstate61nt.
Personally n OR Produced Identification Personally Known OR Produced Identification`s
Type of Ide tific o Type of IdentLic
Prod uc�jed� j Jr r, Prod ed
(Signature of Nota blic-State of lUrida V (Signature of Nota ublic-Sta s
vPu MY AUDREYB•�IUMPHREY
Commission N :<'�eYP�e•, UDREY�@D)NPHREY Commission N t""� '= OMMISSIdG390817
MY COMMISSION#GG 360817 ^
° ExpIRES'March 6,2023
OFF OPS Bop
. 1 ''.;°OF�QN�• Zed Thru Notary �
REVIEWS Pu PLANS VEJ MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.5/6/20