HomeMy WebLinkAboutBuilding Permit Application1
All OPPI IrAw F iNFn miiST RF rnMG',,.--__"n FnR OPDI IrOTInN Tn RF ACCEPTED - -�
Date:
Permit Number: 21 V
RECEIVED
Building Permit Application APR 2 8 2021
Planning and Development Services P9rmitt;,ng partment
St L ee County
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-15S3 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: '� y0-7 San Cakj 6c, UrV--( 01e tf V 1 , S Q q 6
Property Tax ID#:®� ���+' V I�O— ��� L Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
Block No.
New Electrical Meter Second Electrical Meter UP f�,r t_A7 6&VdA,
CONSTRUCTION INFORMATION: v P4-- in 9-0-- 1
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: I �!� Sq. Ft. of First Floor: (OD Sa
Cost of Construction: $ 5,q95 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name . Q�th 01
Name: Y i rr OnacLue no'S
Address: `� OW
"Company: JA CA2W 0
City: Cna pI.o-ra State: rL_
Address: �Q `
Zip Code: _ i� ��� Fax:
City: nc r, t a z-**'
State:_fl—
Phone No. —1 o�' �Dd"l —� Si
Zip Code: Fax:
E-Mail: QfY)0 .YY�CI (��(�f�f If'?e
Phone No ^ `J�J — 3
Fill in fee simple Title Holder on next page (if different
E-Mail
from the Owner listed above)
State o ounty License rnF fr i l� � 5
US I-I3Q_f05- o
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:
_ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: T Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
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 attorney before commencing work or recording your Notice of Commencement.
Signa u of biknerl Lessee/&Rfrotor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF , - LLff"ff
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Prese ce or Online Notarization
Physical Presence or Online Notarization
this�y of 2020 by
this day of . 2020 by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identi
'�� "°t=
Personally Known OR Produced Identification
Type of Identification
Z�
"'-,;;�o�.��
Type of Identification
Produced
Produced o,
mm
(Signature of Notary Public- Stat Florida
—i
(Signature of Notary Public- State of Florida )
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Commission No. (Seal
< v :3 a:3U
Commission No. (Seal)
Q!a - m
C113 0
REVIEWS
FRONT
ZONING
Na W < 1l
R
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
`R
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 5/6/20