HomeMy WebLinkAboutBuilding Permit Application (2) All APPLICABLE INFO MUST W COMPLETED.FOR APPLICATION TO BE ACCEPTED
Date: PermitNumber: ���Q' U
BLUEBI:AM
ss a. Building, Permit Application .
Planning:and Development Services
Building:and Code Regulation Oivis an Con1IT1C'rClaf _ ._ .- R£'.SldeilCl )
23WVirginia Avenue,.Fort Pierce FL 34982
Phone:4772j 462-1553 Fax::(772)4621-1578
PERMIT.APPLICATION.'F"OR,
Address: -110 S L0;C'KW a3 D -D R. EDR ) C } .3 Q l �
Pry a Tax ID# b 3 - Q 193 Inc --
mr �1 � o. -1 cat No. 16
Site PlamName: R Block No.. 2
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Project dame.-
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l l7{+'tt(1 lJN1 'Fo(Z CF c rml 's t D 96 L\/ \ 41_ G 1 C-xy y y In( coo( . 5(65
New Electrical.Meter: - Second Electrical:Meter
Additional work to be performed- urider 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: S Sq. Ft, of First-Floor:
Cost of Construction:S _. ._ Utilities: _Sewer _Septic Building.Height: _
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Name 'i�1i1 1A �M Name sk T iN i yt3tr t`L
Address: "12S L000JWD AA, Company__T'M/DDL t.ne; CRet\) j`JS'TemS it(
City N:O \ .1 LL,el State: T_1 Address 1641 _6f.*In c_4
Zip Cade �� s 1 Fax:: city: Stater,.
Phone'No '61- $d)-i 3133 zip Code•3` 1 Fax:
C'ZM Phone No 17 2.
Fill:in fee simple'Title holder on-next page:(of di:fferent E-Ell ail x
from the Owner listed`above] State or County License SCC- t'j:ji IS i 7
If value of construction is 2SOO or more,a RECORDED Ndtlte of Eornavienceanent is requirtd.
If value of'RAVC Is$7,500 or rml ore,a RECORDED Notice of Corrimence.ment is rdquired:
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I3ESIGNEI;/ENCtNEEtt: Not A licable
pp MORTGAGE`COMPANY Not Applicable.
Name:-CI�A�C�_ Name:
Address�� lG 'i�+ IAP�"l "rCZP1L "nrr �oi Address:
City: Q-%- Crt-iP,- /a E State: t't City:. State:
Zip.S Phone -.0 Zip. Phone.
FEE SIMPLE TITLEHOLDER _Not Applicable SONbING COMPANY: V Not Applicable,
Name: Name:
Address: Address: ..
city
• city.
Zip: Phone: Zip; Phone,' _
OWNER/CONTRACTOR AFFiDVIT:'Application is hereby'n ade to.obtain'a permit to do the work and installation:as indicated.
1 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 orprohibit such
structure.:.Please consult with your.Home Owners Association and review your deed for any restrictions which may'apply:
In consideration of.the.grantingof this requested permit,I do hereby agree thatI will,in all respects,perform the work
in accordance with:the approved plans,the Florida;Builcling.Codes and:St,Lucie County Amendments-
The following building permit applications are:exempt from undergoing a full"concurrency review:room additions,.
accessory structures,,swirhming pools,fences,walls,signs,screen roosts and accessory uses to another non-residential:use
WARNING TO OWNEW Your failure to:Record a Notice of Commencement may resultin 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 f' n. If you intend to obtain financing, consult
with lender or an a_AgrQey before commencing work rk or rec'ording r a of Co ncement01 14,1�
Signatur .of.Owner/Lessee/Contractor as Agent for Owner Signature.of Contractor/License-Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5�:,\n L, C)"E COUNTY OF SP\m ZvGjC_
Swo n to(or affirmed)and subscribed before me of Swor o(or affirmed)"and subscribed before me of
J Physical Presence or .Online:Notarization Physical Presence or Online Notarization
this"day of 202j by. this. dayaf MA 2024. by
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Name of person'ma4cing,sf ement. Name of person making statement.
Personally Known OR Produced Identification Personally Known ti/ ! OR Produced Identification
Type of Identification Type of Identification
Produc Produced_ .
e'��vov4c=. R�BERTERICEPSTEiN '-� ,••�rau�•.,. ROBERTERIGEPSTEIN.
(Signature"of Notary Public ioricta mission#HH Q3576D (Signature of Notary Public-S•' ionJramissron NH 03576Q
oe � My Comm.Expires Aug 24,2024 'FoF tti°¢ My Camm.ExpiresAug 24,2024,
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CDmmis'sion No:. �%J Banded. ti National Notary Assn. Commission.No. �� Bonded t l ational Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR, PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER: REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
BATE
COMPLETED
Rev. 6 20 _ ..