HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLET 9UST BE COMirLc rED FOWAPPEDCATION TO BE ACCEPTEG`
Date: .Alt JUL 2 0 2021 Permit Number:
g� IL St Lucie County
o -
Permitting
O �M
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential 'J�\
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: J nC� l'e Fa M, Ht-rv'
R,ROPOSED IMPROVEMENT LOCATION:
Address:
2 . f'1(.t�l-(' l-►� �Sor� is an
Property Tax ID#: IY �oo� ��0� 3 oioa9 Lot No. �30
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION
Block No.
Additional work to be performed under this permit- check all that apply: /
Mechanical _ Gas Tank _ Gas Piping _ Shutters V Windows/Doors _ Pond
Electric ZPlumbing ✓Sprinklers _ Generator _ZRoof Pitch
Total Sq. Ft of Construction: 3 90/ ? ea Sq. Ft. of First Floor: �, "�'qo ! I:
Cost of Construction: $ 2)9-91 & to u�" Utilities: —Sewer, YSeptic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name hl'r- f' Ka.4
Address: /�% / `) rlofic-I& 13)y •
Se(
Name: - tk'64-vi
Company: \R:�->
City: J ,4P �l-, Stater_
Zip Code: j�Fax:
Phone No. '�;3(0
E-Mail: Q5 nQ-L
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Address: RC>LE3 4v,-e
City: vzrp 6ea4hStater
Zip Code: J&:�-9(2 () Fax: fl
Phone Norr-7 W -4e� 3 - -9 7 �
E-Mail bagonquil 4P A-0 L . ���
State or County LicenseCC1C, [Q1c�
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.
SUPPLEWNTA'L 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 C9,6nXy and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lefide'r or an attorney before commencing work or recordWg your Notice of Commencement.
Signatu
as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF I � r� � � COUNTY 0 Ci�l &Ve�
Sw rn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this j<')ay of vim_ , 202f by
Name of person making statement.
Personally Known OR Produced Identification
T p of Iden 'fcai;ion (,�/ rod ed I �J I C! Lj.�iy�e
Signature of Notary Public- Sfit
f rid��pry Pubic scare a Fi«;da
Paltricia K C,ollins
�j : y commission GG 248872
Commission No. b r�;� ( iF�s 00/2412022
S n to (or affirmed) and subscribed before me of
P ical Prese a or Online Notarization
this ay of 202f by
Ali
Name of person making statement.
Personally Known 4 OR Produced Identification
Tvr)e_of Identification
re of Notary
mission
ranjeleu K gottins
►ywti ..irnniSSipt� GG ?,i8a,72
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