HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: �'� �� Permit Number: - do7 1
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RECEIVED
21ro}j�jL UCE
o AUG 0 9 2021
Building Permit Application St. Lucie County
permitting
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Residential x
PERMIT APPLICATION FOR:
PROPOSED 111%IPR'OVEM'ENTL�OCA4TI'®N
Address: 330 Smallwood Ave, Fort Pierce, FL 34982
Property Tax ID #: 3403-805-0091-0001
Site Plan Name:
Project Name:
Lot No.
Block No.
e r r sn �� r � � t 1 �: ��'.'.{ s � � �� a �
DETAILED DESCRIPTION,`OF.WOR'Kpt,. ', _,:,'.� y}
ci.�,Oyk . �l'U n /'�r Q Y7 ex ) s4; » n C 1/ )",
New Electrical Meter Second Electrical Meter
CONSTRUCTION IN'FOR11/IATI'ON7
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric _ Plumbing
y _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 0 , ( 00 —
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
Ow SEE,
„.
Name George Gordon
Name: J,--w-,es I&4 e
Company:S0UkV-e'rVn sc✓eeA -'�o ��VYLJ
Address: 330 Smallwood Ave
City: Fort Pierce State: _
Address: 7Sa SE LAD�i LA
Zip Code: 34982 Fax:
City: Ta/-� 5+. GQ�; e- State:-E(-,
Phone No. 772-464-6962
Zip Code:-Lic8r3 Fax:
E-Mail: momthelovedone@att.net
Phone No r77a 7o?--T`I3v
E-Mail ��)-aw�ji►ee..s: G�hs �� 1ha�� c o
Fill in fee simple Title Holder on next page ( if different
State or County License `,)Jr
from the Owner listed above)
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`LLEN LAW INFORMATION
DESIGNER ENGINE�jR: _ Not Applicable
pp
MORTGAGE COMPANY: _ Not
t Applicable
Name:e; Jt
Name:
Address: %O ( SSo,A�9_ 140
Address:
City: State: FI
City: State:
Zip: 33( 01k Phonel'13 37N —D403
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ 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 commencing work or recording our Notice of Commencement.
Signature of O er/ Lessee ontractor as Agent for Owner
Signature Cont cto License Holder
STATE OF FLORIDA
STAT OF IDA
COUNTY OF Saint Lucie
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
x Physical Presence or Online Notarization
Physical Presence or Online Notarization
this day of 2021 by
this c -> day of cg_" 2021 by
Ge-C/tiJ� ��f-�od_1�C—
&
Name of person making statement.
Name of person making statement.
Personally Known x OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identific "ion
Produced
Produced
(Signature of Notary Public- State of r4brida)
(Signatur P-0S0/of/9
VIRGINIAGOING
'$
s ioa NotarN
C* n. (Seal)
*
._.. :My
Commission �G2j 1
slo1
Expires May 28,2026
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