HomeMy WebLinkAboutBuilding Permit App, 21-145A OHS Unit 808 Bldg A -All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
�..
Building Permit Application
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
Address:
r�
3�i'�II9
Property Tax I D #: /� 2 3 5'a! QOIo t; boob Lot No.
Site Plan Name:
Project Name: 0�111 !-IAR80'(� SouYH
Block No.
CaNC�'�r� /Q�STaR��aN �T SG/�1�o GlsISS haoCzS DM f3ALGaNy
New Electrical Meter
Second Electrical Meter
Additional work to be performed under this permit —check all that apply:
Mechanical _Gas Tank _Gas Piping _Shutters
(Affidavit required)
Electric _Plumbing _Sprinklers _Generator
Total Sq. Ft of Construction:
Cost of Construction: $
Name
Address: � ZO '%�L
City:�o %�EigG}� State:
Zip Code: 379&0 Fax:
Phone
E-Mail:
_Windows/Doors
Sq. Ft. of First Floor:
Roof
Utilities: _Sewer _Septic Building Height:
Name:' �agER� S��K
Company: 'TV%*2m
Pond
Pitch
`gCity: 2�I��f'ia/3�rG State:
Zip Code: ��73 Fax:
Phone No '172 Z.1 <' S6 31
Fill in fee simple Title Holder on next page (if different � E-Mail
from the Owner listed above)
State or County License CCrG oho j A�3
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW] N FORMATIOW
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: ML EN61 hrL* fNG /NG
Name:
Address: Za3o 57 AvF
Address:
City: State:
City: Vim° Aqu State:
Zip: 32,960 Phone 7y1. $'to9 12TI
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 1 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.
Yml�
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA ,
COUNTY OF �T_nrl
Sworn to (or affirmed) and subscribed before me of x Physical Presence or Online Notarization
this I ��day of Jur-ie. 20 by
Name of person making statement.
Personally Known /` OR Produced Identification
Type of Identification Produced
(Signatu e of Notary Public- State of Florida )
�G252.7t)3 (Seal) BETHCTHOMAS
Commission No. `_°����., Notary Public -State of Florida
� Commission # GG 252703
FC, OF °: My Comm. Expires Sep 26, 2022
Bonded through National Notary Assn,
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