HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE` INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED'
'Date: s1� a� Permit Number:
RECEIVED
2 llo ILUCUR;:n
9410-PROKS Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
MAY 0 4 2021
ParmittLng Department
St. Lucie C,ountty
Commercial Residential v
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address:-� -
Property Tax ID #: R )rirk -1�JY' - '�'1�I 1 � U�/� Lot No.
Site Plan Name: [ ,�r 1 Unt c c:)- Block No.
Project Name: ���il CA l
DETAILED DESCRIPTION OFWORK:
r
1 �
New Electrical Meter Second Electrical Meter
Uut_�Sr-
r,mcmS.
I CONSTRUCTION INFORMATION: I
Additional work to be performed,. under this permit - check all that apply:
_Mechanical Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric Plumbing _ Sprinklers _ Generator _ Roof
Total lSq. Ft of Constru tion: Sq. Ft. of First Floor: _
Cost of Construction: $ tots 1dd6•ad Utilities: —Sewer —Septic
Building Height:
Pond
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name ({YC�,t,,��0(-�
Name:
Add ress:q�(M�j.QCf0r1 o�Do�
Company:
Address: 16q I SG_4 W6
City: ��(15 1 f? C'�AC,�1 State: iS,
Zip Code: �5�6 Fax:
Phone No. 71-J-U,30-(EA
City: PUA- 1-• Lde— State: F
Zip Code: Fax:
Phone No
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-MailCnrlks C )bue-lf ckG r-cd ES�G�f ,C4
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. oZ�S
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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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 su sect 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 roperty. A Notice of Commencement must be recorded in the public records of St.
Lucie County and post on the jobsite before the first inspection. If you intenWotain financing, consult
with len er or an a t r e before commencin work or recor In our Noticemencement.
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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:
Signatur f O r/ Les 'e C n r ctor s Agent for Owner
Signature of�ntr for 'ce Holder
STATE OF ORID
COUNTY F
CTA £�¢ OFFORI ��
Sworn to (or affirmed) and bscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
� Physical Pres nce o Online Notarization
this day of y
this � day of l 200 by
S
�V�i�IS V�1l�LC�
Name of person making statement.
Name of person making statement.
X
Personally Known �` O r u e Identification
Personally Known OR Produced Identification
Type of Identification
Produced Notary Public State of Florida
pe of Identification
roduced
TRACY CARVALHO
..� My Commission GG 950192
Expires 03122/2024
a w
(Signature of Notary Public- State of Florida
Signat e��tarwgt�44�66ir�Pagtf oaf a
TRACY CARVALHO
Commission No. (Seal)
Commis �pw � MyCommisk�sionGG9so192 ( al)
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