HomeMy WebLinkAboutST L County Permit, 07.28.2021All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �•'n[!� — c��
Permit Number-
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ar
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce Ft 34982 /
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial ReSidentiai 1•//
PERMIT TYPE: H 011liilo
PROPOSED IMPROVEMENT LOCATION:
Address; �7^'—T/'leor Ca.� I SIP t r� �P7
Property Tax ID: 3 10 -SO - — —
Lot No.
Site Plan Name: r eA L O 2 Black No.
Project Name:
DETAILED DESCRIPTION OF WORK:
3, 2
59-NSTRUcTiON INFORMATION:
Additi nal work to be performed under this permit —check all that apply:
!Mechanical
_Gas Tank Gas Piping _Shutters Win doves/Doors
^Electric ,Plumbing _ Sprinklers r _Generator Roof Pitch
Total Sq. Ft of Construction: 13 g2sj
Sq. Ft.
of First Floor:
Cost of Construction: $ 1 utilities:
—Sewer — Septic Building Height:
OWNER{LESSEE: J `
CON —TRACTOR:
Name
Name:
Address: f Company:
A
City: ric el`e State,
Address-
Zip Code: 3MC�L Fax:
,
City:'DIIII-I ,�'-�- ,c1C12. State:PL....
Phone No. 7a - q 6 q' qY3b
zip Code: 3 R k :? Fax:
E-Mail:1kWAK
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail��i
from the Owner listed above)
State or County License C t'}C 18/89'7 r7
If value of construction is $25€ 0 or more, a RECORDED Notice of Commencement is required.
If value of NVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Z Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable 1
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
BONDING COMPANY: Not Applicable
Name: —"
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.
14 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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPEL. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE ST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WIMYOUR LENDER O%AN A EY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
S' at of Owner/ L e/Contr or as Agent for Owner
ature of t or/Li s er
STATE OF FLORID _
STATE OF FLORIDA
COUNTY OF .S^7-. L ()C t P_'
COUNTY OF S T
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of 20W by
this day of 20C�,( by
1 V.c p
S (A Jkk a -MS
Name U person making statement.
Name of person making statement.
Personally Known —� OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
4i&gnature of Notary Publif,,�lorida4l ICIA HIGGINS
nature of Not ate of Florida
?Notary Public -State of Flo
=* *z fission # GG 9563
Commission
ida _* *� Commission # GG 956362
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NO. .`.... f,,,oP�� ommission Expire
mission No. ��� My Comm�Expires
2024
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'����� February 09, 2024
t0 �FRONT
February
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Rev. 2/7/19