HomeMy WebLinkAboutBuilding Permit All APPLI BLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:�0 7• Permit Number:
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RECEIVED
JUN 01 2021
P L c i z_l L Ll, l + ~^ BuildingPermit Application Permitting Department
pp St. 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:
PROPOSED IMPROVEMENT LOCATION:
Address: 7 �d17 �-� ►�t��.b.-tit 1�1�1��z� ��.�c—R�k _
Property Tax ID#: -)c>C-> _ Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
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CONSTRUCTION INFORMATION: j
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 k :; l Pitch
Total
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ \Z- add Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACT:)R:
Name Name:
Address:_ 4r-7 k I >NA1 Q Company:01Ir-k�5 �• �-� `P��* •.
City: �'-� �, _ State:'. Address:15<5�j C'C� �,� 1= -',
Zip Code: Z Fax: Ci
��� State�A
Phone No. r( 27- ^ 2UT3'd h-2 Z Zip Code:-:?;X�C�C5 Fax: _
E-Mail: Phone No -�J-T-7- �'72-7 37 S_
Fill in fee simple Title Holder on next page(if different E-Mail Sv►���cc f� �4�'�4��
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from the Owner listed above) State or County License(2�
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 regt'red.
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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.
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
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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 Commenceme,it may result in paying twice for
improvements to your property. A Notice of Commencement mL..i be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspectior If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF Sk.Y-\3���
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of a;
Physical Presence or Online Notarization Physical Presence or Online Notarization
this day of 2020 by this day of -,5uvk 202p by
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Name of person making statement. Name of person making statement. '
Personally Known OR Produced Identification Personally Kno ,n OR Produced Identification
Type of Identification Type of Identification
Produced Produced V-\. !D�..
(Signature of Notary Public-State of Florida ) (Signature o�Ntary iblic-State of Florida )
DEASIi{Q GIVE"S
Commission No. (Seal) Commission No. Cary of;torida
Commission-HM 086359
fires.;an 28.2025
hNationa Notary —
onded throng ).,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETA A ciROVE
COUNTER REVIEW REVIEW REVIEW REVIE REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED Rev. 5/6/20
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