HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dater 1 Permit Number: ��aJ1�d5
p -• RECEIVED
Q .a ° ' Building Permit Application
JUL 19 2021
Planning and Development Services
� 6ucaf8 �y
Building and Code Regulation Division Commercial Residentift' .
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR: NJ
PROPOSED IMPROVEMENT LOCATION:
Address: 67 !� �N ��5� y,-1 r3 lY3
Property Tax lD#: 3j�/ _220 00 32000_6_ Lot No.
Site Plan Name: /36rvz�Tz 7`�l.Ei��g7c�� Block No.7,5-
Project Name: 4,Fz,1iZo_
FDETAILED DESCRIPTION OF WORK:.
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 V/ Roof / i/Z- Pitch
Total Sq. Ft of Construction: /"7OU Sq. Ft. of First Floor:
Cost of Construction: $ d0 Utilities: —Sewer _Septic Building Height: /,,L
OWN ER/LESSEE: CONTRACTOR:
Name - 196y/f0 fi�'/�l21.�pcc E Name: 5�2 72 '-a2aV W lSr'y<1�6 V re
Address: 7io9 l7 Company:�ic/2 %fe� ,coa6,w-'
City: b lsE State Address: 5z6/ IV w 6;4A"w-#q- �
Zip Code: ciG 3 _ Fax: City:_ _pOIS Stater
Phone No. /_5�'g Z!a Zip Code: a WY6 Fax:
E-Mail: /✓�� Phone No Z33 1- OS Z
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License Ccc t 3 v8 9
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.LI'EN,"LAW INFORMATIQ'N
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Add ress: 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 an applicable Home Owners Association rules bylaws or and covenants that may restrict or prohibit such
structure. Please consult withpyour Home Owners Association and review your deed for any restrictions which may aply.
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
'Al'ADhimit:Tv fffl"IER: Your failure to Record a I:rotice of Comnmenceem=ent 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 leaor.Qy an attorney before commencing work or recording our Notice of Commencement.
11,411
Sig at ' of O n (see/Contractor as Agent for Owner
I
STATE OF FLORIDA
COUNTY OF ,1914WIVIe)
Sworn to (or affirmed)and subscribed before me of ✓ Physical Presence or Online Notarization
this 1L day of 3G[l� 20ZL by
IN�SIy ��.v,�i�ar2
Name of 477son making statement.
Personally Known V OR Produced Identification
Type of Identification Produced
(Signature of Notary Public-State of Florida )
=o,0Y P`@4n Notary Public state of 1 lofidW
Commission No. (Seal) � my co Beauchamp
y,_ oQ my Commission GG 230800
'do
Expires 06/20/2022
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DATE
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