HomeMy WebLinkAboutBuilding permit app, 21-145B OHS Unit 609 Bldg Permit App - STUCTURE CONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
a UT
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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
PERMIT APPLICATION FOR: CoNcrft6't'c� �£Sfo�dT��K L/ ( W
Address: �fz.Ov N.
T LOCATION:
A 4f�% Oq �C `el Ekce aFL 3441 Li
Property Tax ID #: /Lj2 3 �O/ 0/ 3 7 OG►d 9 Lot No.
Site Plan Name:
Project Name: OCEXrU �RR
New Electrical Meter
Second Electrical Meter
Additional work to be performed under this permit —check all that apply:
Mechanical
Electric
Gas Tank
_Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
Gas Piping
_Sprinklers
Block No.
(Affidavit required)
_Shutters
Windows/Doors _Pond
Generator _ Roof Pitch
Sq. Ft. of First Floor:
l�tilities: _Sewer _Septic Building Height:
XL NameLlo77 Lgk1tjk a ��'16J � wty I'hcji �j I
Address: 52 20 7't` PLAce
ra pE��l City: `W State: l
Zip Code: ?ZJ46 Fax:
Phone No. 772
E-Mail:
Fill in fee simple Title Holder on next page if different
from the Owner listed above)
Name: _ iLv�r :�jA�%
Company: S�4Jg0 9E - C OQ
Ada• 35yy 2.40 24
dress: e
City: 4!( 0/3&E State:
Zip Code: .3�ry7 3 Fax:
Phone No 77Z 2��31
E-Mail Struc+� Sr c.an �D
State or County License ('GC 04f 03
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 INFORMATION;
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: 14L 46N61A4f9 Pjh16, VVCe
Name:
Address:2D10 31 QrE
Address:
City: YEto J*LACt1 State: L
City: State:
Zip: 3Z9GO Phone 172 /ZS7
Zip: Phone:
�S"!v9
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
I
n 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 at Qrney before commencing work or recording our Notice of Commencement.
Signature of Owne / Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF .1_nd iax,) P I Vim'
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this 0%+ day of Jt.Cne 20 21 by
V erg F��s�
Name of person making statement.
Personally Known X OR Produced Identification
Type of Identification Produced
Al'q'k C•
(Signatu of Notary Public- State of Florida )
/' / 252 /0 (Seal)
BETH CTHOMASCommission No. �(� ) tary Public -State of FloridaCommission
# GG 252703
E4�
Comm. Expires Sep 26. 2022through
National Notary Assn.
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