HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO -MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED F
Permit Number: ��d�'°
- RECz-:IVEp
MAY 11 2021
Building. Permit Application "Mini gDCountyenr
Planning find oevelopmentServices
Building and Code Regulation Divislon__�_ COmmerdial Residential
2300 Virginia Avenue, Fort Pierce F1134982
Phone: (772) 4462-1553 Fax: (772) 462-1578
r
PERMIT APPLICATION FOR: lZ��,� ���L, Cor_ ^_, ,•_,.��a�rce,E �2��
PROPOSED 1MPRQVEMENT LOCATION:
Address; 30 �' 3 y9s -7
PropertyTax lu#: O,V 9S- e) oo - 7 Lot No. 30
Site Plan Name:��� Block No.
Project Name:
v
[DHAILE-P._bESCR*IPTIQN':0:F WORK:
myrL
P,iA
' � U
New Electrical Meter Second Electrical Meter
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: /J_A Sq. Ft. of First*Floor:
Cost of Construction; $ Utilities: _Sewer- _Septic Building Height:
OWN ER%LESSEE:
CONTRACTOR: ,
Name
Name:
Address; 30 911P,
iyp(J
Company:
City: `gJ& "2'X •State: a
Address:A &tew&e�r1ri_ ice_
Zip Code:,,,�Z9, E2 Fax,
City:-�vr : State
Phone NoT1-,9 s'6 7
Zip Code:.�9�",3 Fax:
E-Mail: ¢i»ta s2 , CGyyL
Phone No( -7=) -Ae 27
Fill in fee simple Title Holder on next page (if different
E-Mail j1 b 00 Nl S t 2P 92ff 4;4 ► 0-OVY1
from the Owner listed above)
State or County License
If value nf-rnnctns�.^m -.. -2enn
o..,�.a.vnucu ,mutow or uummencemenr is requirea.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LiEN LAW INFORMATION:
City: 9, St
Zip: A391`A , Phone 9!,�� �s 9/- aS' ate: ate:
FEE SIMPLE TITLE HOLDER: X Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: �(� Not Applicable
Name:
Address•
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City..
Zip: Phone:
OWNER/ CONTRACTOR AFFIDMT: 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 Horne Owners Assoaation 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.
LucieCo.with lender aan posted oh
hth jQ site before the first inspection, if you, intend to obtain financing, consult
- o ----� v... 91-1 — eei4onvaaor a ent for Owner
STATE OF FLORID
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Onfine Notarization
isday of 20& by
hS
Name of p bn ma ' tatement.
Personally'Known OR Produced Identification
Type of Identifigtio
Produced
(Signature Of Notary Public- Sta a '�'aF�"
unnie Merrill Woodard
1 i My Commission HH 03S
Commission No. goZ +.Oteinpirei09/0712024
STATE OF FLORIDLuc,
COUNTY OF
Mw r to (or affirmed) and subscribed before me of
Physical Pres a or Online Notarization
this., day of 2o2L by
Name of pers6h makingstAteinent
Personally Known A� OR Produced Identification
Type of Identification
Produced
of Notary Public , o or ry Public 'Stagy of Florid
Bunrne Merritt Woodard
iY NO. : �11ggl�miswon HH 039826
•_e� Exp res 0910712024
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