HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE
COMPLETED FOR APPLICATION TO BE ACCEPTED �1
Date: 6' 1 Permit Number: �/ y
_' l. _ .... RECEIVED
s:
• - JUN ®7 2021
Building Permit Application ..
Planningand Development Services Permitting Department
P St. ucl County
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:
PRIMPOSED IQi RQUEMENT lQCATIQN:
Address: 53 0 q 3 /V D t e-ci® A A/P,
Property Tax ID#: f I -7ot9 ` o0I 00 Lot No. f 6
Site Plan Name: Block No.
Project Name:
D AILED DE�SCR�IPT(ON OF WORK: :
l�o u 12 /Vey b-f I`ve wfl 4/ i`dt c�eS C, jO.W'Cre�
p
New Electrical Meter Second Electrical Meter
CONSTRUCTI NN (N=@RMATION:
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
in
Total Sq. Ft of Construction: G a D ✓g,, r-� " Sq. Ft. of First Floor:
Cost of Construction: $ B ®d Utilities: —Sewer —Septic Building Height:
OV . ;JLE1S`�SEE: CONTRACTOR:
Name Vf� Name:
Address: 6 �/� o uC' Company:
City: P; COX ce__ Stater Address:
Zip Code: 3 Lt 9 Fax: City: State:
Phone No. t�-ea LIT `3:7 Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail
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.
` SUPPL MENTAL CONSTW1CTtON LIEN LAW iNFORMAT{0 .
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 financing, consult
,with ender orA att4rney Vefore commencing work or recording our Notice of Commencement.
Sig ture of 0 r/Less e/ ont actor as Agent for Owner Signature of Contractor/License Holder
STATE OF L , RID STATE OF FLORIDA
COUNTY O COUNTY OF
Vto(or affir ed) and subscribed before me of Sworn to(or affirmed)and subscribed before me of
al PrefOVce or Online Notarization Physical Presence or Online Notarization
this ay of tZi 1 21_ by this day of , 21_ by
ALA -H A�Iaz�
Name of person ma g staf6rdent Name of person making statement.
nProdu
Ily Known�ZOR Produced Identification Personally Known OR Produced Identification
Identification Type of Identification
d Produced
. f
(Signature of Notar P lic-State of Florida ) (Signature of Notary Public-State of Florida)
Commis ion No. (Seal) Commission No. (Seal)
�o1�Y POk caS$MA BRADLEY SANDERS
° my com,{Is"#GG 087080
e� IRES;,tu}�I 10,2021
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