HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE -INFO MUST BE COMI'L _,� 113 FOR APPLICATION TO:BE ACCEPTED '
Date
�; Permit Number
RECEIVED
- FEB 0 4 2021
Permitting
Buifding:Permit. Application 9-CCbF1t,1
. St. Luc1e CdUhty
Planning and Development Services
Building and Code Regulation Division COTI'1T7YeCCial ReSidebtial "✓
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: 3-AkA 4-�YIN \ 1�OJ,4— T%)"V
Property Tax ID #: 3 l �15 Lot No. Z 5
Site Plan Name: ` C'tY a 'SLAB Block No. 3 Z
Project Name:
New Electrical Meter Second Electrical'Meter �®02
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Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank —Gas Piping
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: 1
_ Shutters _ Windows/Doors % Pond
Generator . Roof Pitch
Sq. Ft. of First Floor:
Cost of Construction: $ 2 Z. o ®Q Utilities: _Sewer _Septic
Building Height:
Name s,�v.\ 'yam ame:
Address: 314 • S . �o,xy.n�a �'u �- Company:
City: Too cza>r� Lv c>� State: 'Fl• Address:
Zip Code: 3-� �A % 3 Fax: City: State:
Phone No. 3 �i `�� Zip Code: Fax:
E-Mail: N'rl") �- �-�`Fy��.il-C�'d+'1 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.
.:.
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY Not Applicable
Name: 'cove �s.7 kN �� 1�i Name: 'Lo A" ��v0 ,
Address: 99%4 g•w- # )Iq Address: ?• c� C'xix' ^iv zc�'.Z
City: State: 'Ft- !F LQ 6.� n c Q { State: .
Zip: 3'-4,A`3g( Phone Zip: Zy ray'L Phone 39 - Z t�S Q►Z 3 i
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:'
i
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 installatiomhas commenced prior to theassuance.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 Amend i ents.
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 lanother non-residential use
WARNING TO OWNER: Your -:failure to Record a Noticev Commencement may result in paying twice for
.
your
improvements -to your prope A Notice of Commencement must be recorded in the public records of St.
Lucie County and t e j site before the first inspection. If you intend to obtain financing, consult
with lender or an actor ,e ' h• ,ore mmencin work or recording your Notice of Commencement.
i
ignature of Owner/ Lessee IContrac r as Ag t for Owner Signature of Contra ctor/Liclense Holder
STATE OFTLO ITA STATE OF, FLORIDA
COUNTY OF 1 �c ':
COUNTY Of .
Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) andl subscribed before me of
Physical Presence or Online Notarization Physical Presence or I Online Notarization
this day of �ctl 20A� by
this day of I 20_ by
Vc-2,
Name of person making statement. Name of person making statement.
/ I
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced t, l— Produced
(Signature of Notaff Public- State of Florida) (Signature of Notary Public- State of Florida )
Commission No. o1oYPiBo, K� S. NIELSEN
;State` rida Notary Pubic Commission No. (Seal)
=* *� Commission # GG 207484
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9 ova
ion Expires i
Juna
12, 2022
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