HomeMy WebLinkAboutBuilding Permit Application i
All APPLIC BLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: '� a� Permit Number: CCU I
9 IJo L UC RECEIVED
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47
Building Permit Application AUG 0 4 2021
Planning and Development Services St,Lucie County
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(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:
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PROPOSED IIVIPROVEMEaNT LOCATION
Address: �a�\ � ��� CX'r
Pi operty Tax ID#: �3\-L- c,Z'Z.S -c,_C2)n Lot No.
SiIte Plan Name: Block No.
PI oject Name:
DETAILED DESCRIPTION 0F.V1/ORK
Niew Electrical Meter Second Electrical Meter (Affidavit required)
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CONSTRU CTI ONF I N FO RMATI ON
Additional work to be performed under this permit-check all that apply:
_Mechanical _Ga's Tank _Gas Piping _Shutters _Windows/Doors _Pond
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Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ �V>4CYp-C-,cp Utilities: —Sewer —Septic Building Height:
OUVNER/LESSEE :CONTRACTOR.`°
Name Name: oa'_t,� l,%�);
Address: 672-\\ C�tzP_j oLv Company: 1
(City: 44— p State: -1"1— Address: 2 ,-? N c,nk Lc, �r
Zip Code: 3Nck Fax: City: - `P r- State:�C_
(Phone No. L/c�[- Lf 2.g� I�1?� Zip Code: qc{ L'I S Fax:
E-Mail: Phone No �7-)7
(Fill in fee simple Title Holder on next page(if different E-Mail _
from the Owner listed above) State or County License CPC--IL-k $7 8t(3
If1value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
It value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
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;DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone I 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,swimmingpools,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 commencing work or recording our Notice of Commencement.
Signat a of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
'COUNTY OF • ��yCl�
Savor o(or affir �su6!scribed be rq me of Physical Presence or Online Notarization
this day of 20L by
(Name of person making statement.
Personally Known ORI Produced'client!iion
ype of Identificatio roduc s
(Signature of Notary Pu Ic-State of Florida)
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Commission No. (Seal) KAREN S. NIELSEN
PVB
�p;State of Florida-Notary Public
=� *� Commission #GG 207484
My Commission Expires
June 12, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW. REVIEW REVIEW REVIEW REVIEW
BATE
RECEIVED
DATE
;COMPLETED
Rev 5/20/21
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