HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Date:
RECEIVED
r Building Permit Application JUL 2 7 2021
St.Lucie County
Planning and Development Services Pe.
Building Building and Code Regulation Division Commerciai Residentiai
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772).462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
PRdPQSEC� NPR'O (EI E4T LOCATIaN7.
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Address: 1102 BUc_keye Dr., Fa Pierce, FI
2AnA �ng ngAAnn Lot No.
Property Tax ID#:�,�...� ,�• ��- a2
Site Plan Name: Block No.
Project Name:
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New Electrical Meter^ Second Electrical Meter (Affidavit required)
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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 X Roof Pitch
Total Sq. Ft of Construction: 7'S+/ Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: —Sewer _Septic Building Height: _
DINER/LESSEE `, 4VTR/\ �R S +
Name Stephen Dornfeld Name: Richard Newland
Address: 10007 Bia&Qye Dr Company: Richie the Roofer lnc,--
City: Fort fierce, FI State:Ff Address:- 902 13th SYJ
y: Vero Beach, FI State:FI
Zip Code: 34982 Fax: Cit
Phone No. Zip Code: Fax:
E-Mail: _ Phone No 772-473-6197
Fill in fee simple Title bolder on next page(if different E-Mail
from the Owner listed above) State or County License CCC058021
If value of constructiori is 2500 or more,a RECORDED Notice of Commencement is required.
if value of HAVC is$7,$00 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 commencing work or recording our Notice of Commencement.
S' ature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA—
COUNTY OF
S�TJ
or affir )an subscribed befor me of Physical Presence or Online Notarization
thay of 20�by
0 J10 A J d
Name of person making statement.
Personally Known OR Produced Identification
Type of Id tification Produc d
(Signature of Nota Public-State of Florida)
Commission No. _ A (Seal)
F00.
P" Notary Public state of Florida
Amanda P Sanderson
My Cummission GG 211256
Expires 04l25I2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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DATE
COMPLETED
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