HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 7�o?r],L2WI Permit Number: 10NNd�
RECEIVED
JUL 2 7 2021
U Building Permit Application p� 5t.Lucie County
Planning and Development Services Permitting
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR. .�
PROPOSED IMPROVEMENT LOCATION:
Address: rQ�c Avenuc, R ?\cxC?_ r l��.3 q 51s
Property Tax I D#: 0308"3 j "0063—O04 — 8 Lot No.
Site Plan Name: Block No.
Project Name:_
DETAILED 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 Y Shutters _Windows/Doors Pond
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: D C) Sq. Ft. of First Floor:
Cost of Construction: $ 00 , 0 Utilities: _Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Nam e \O>✓ Name:
Address:oPqD DuS< LA Company:,a.L,LW-t Si+e DeVd�e1vl
City: t���r State:Fl Address:gr,(s�> gW
Zip Code:3�9 LIS Fax: City: State:Fl-,
Phone No._772 •33Z-&5)C1 Zip Code:Sy 9182— Fax:77.Z MAO LPQ42)
E-Mail: Phone No q9a •gLP5. 303a
Fill in fee.simple Title Holder on next page(if different E-Mail aSc�ey Iy-%c,C)L—) O'DIo corn
from the Owner listed above) State or County License5k- 1_tkC iG 0Dl�Yr14U
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 cWnmencing work or recording your Notice of Commencement.
Signature of Owner/Lessee/Contr or as Agent for Owner
STATE OF FLO I A
COUNTY OF u'(
Sworn to(or affirmed)and subscribed before me of Physical Presence or —Online Notarization
this day of JUA LA 20.1 by
Name of person making statement.
Personally Known OR Produced Identification _ _ t;a�o� KATHY REIN
Type of Identification Produced =,: Commission#HH 118816
Expires April 19,2025
L LJV\-- kaa F�° Bonded Tiuu Troy Falq Insurance 800-385-7019
(Signature of Notary Publij State of Florida)
,�II ;o��wyP, ' KATHYREIN
Commission No.+t��61 CP (Seal) *' *=Commission#HH118816
; ;3` Expires April19,2025
'•".�P f;°P' Bonded TMu Troy Fafq Insurance 800a85-7019
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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