HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 7,
O
RECEIVED
Building Permit Application JUL r 2,2021
Planning and Development Services
Perm g Department
Building and Code Regulation Division Commercial Residential t.Lucie County
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 115 N3prAAg i 1,6rar1TLVAnt1-2'Pork Ut_.z..l 3y°1155
Property Tax ID#:,3�An- 30-o?zn -0oo Lot No. c13
Site Plan Name: pjiVtr Ro,o— -VK\i*� Block No._3'�'J
Project Name: CYUYl&
DETAILED DESCRIPTION OF WORK:
:rear - -
0prcA 1_0VCLl —I
RO�V�t5 . i-EL1n
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
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: 3.11?n Sq. Ft.of First Floor: 31'1 35 S P 4-u 1
Cost of Construction:$ ,°1���5. a Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: . CONTRACTOR/I:
Name �Y1y" I AljSGlfV`0�. Name:�Web (Xo s
Address: 115 01 I�arn'lCk- Ay`2 Company:�16rickx gwnrcr COM71 r�cn
City:yy-l_ q LULL Stater Address: 1Q1 rj V�100c�(OUn- a
Zip Code: ?4ftS Fax: N1W} City: cinnd,0 State:.
Phone No.-11 2' (A3[•'9O a'-- Zip Code: :92863 Fax: P1 Fr
E-Mail:_�IY� gS�l,0�►'1�{I �L(�yN1 Phone No �i�'� -•G��D�
Fill in fee simple Title Holder on next page(if different E-Mail YNVIif Ara
from the Owner listed above) State o County License 3
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.
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 attorney before commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF CkQgo�
Sworn tQ(or affirmed)and subscribed before me of ✓ Physical Presence or Online Notarization
this day of 2nI by
or
Name of person making statement.
Personally Known OR Produced Identification
Type of e i a ' duced
(SIgnalure of No—tary Public-State of Florida)
Commission No.A osq rsa (Seal) MARC DAVID BOUTILIER
- Commission#HH 089153
Expires February 4,2025
:VoFF°` Bonded Thru Troy Fain lnsurance800.385-7019
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 2 21
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