HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLI//C,A,,BLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �1
Date: T 3 I 2.DZA Permit Number:
91ro [LUE [ ; Z RECEIVED
SON 4 2 ° i , Building Permit Application ,JUN 2 3 2021
Planning and Development Services St. Lucie County
Building and Code Regulation Division Commercial Residential Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: bol)(Z Qlhd W I It1 DO W S
;PROPOSED IMPROVEMENT LOCATION:
Address: 01 auf L4 nW— Qr '� F /J2
Property Tax I D #: V 3- O d 0 b zJ Ci Lot No.
Site Plan Name: pp '' Block No.
Project Name: TIre, II'L LL�.
DETAILED -DESCRIPTION °OF WORK
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1/15) (A I YI tn(u ).S I M M r.
ry-1
New Electrical Meter Sec(dnd Electrical Meter y
CONSTRUCTION ° I N FO RM ATI O N':
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
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ h �. 0 Utilities: —Sewer —Septic
Building Height:
OWNER/LESSEE:,
CONTRACTOR:
Name
A
lice tacijcl Inn LING
Name:
Address: 1fQ R4 - ►-
Company:
ass 4M (cod
City:' State: P-0
Zip Code: 15 7 b, Fax:
Phone No.
Address: S
-go
City: ?
Zip Code: 3(-%95 ZGG . Fa
Phone N�o - 3J , , %2
State:-L.
1i 1 Z I (y
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail ) kes U C
1 ►
, 0 i
State or County License 15 f Is
I ZSq
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.
=I
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
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 attornev before commencing work or recor4ing your Notice of Commencement.
111120?-2 CA /C—�
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signa ure of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
STATE OF FLORIDA
COUNTY OF Sk. W6 P
Sworn to (or affirmed) and subscribed before me of
Swcyr n to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of 12020 by
,/ Physical Presente�e or Online Notarization
this � day of Junt 2024 by
a iKe 5 A cak0
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known V OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
CI
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of FI Notary Public, Stateo
Commission No. (Seal)
*.f�� Commission No.
Commission No.('- 9'q0%y Commission Expires
G
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 5/6/20