HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPL�:-41) FOR APPLICATION TO BE ACCEPTED
Date: -7/ 2 / Z 1 Permit Number:.
9 r. [LUC E
Building Permit Application
Planning and Development Services
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:
PROPOSED IMPROVEMENT LOCATION: `
Address: � � V>�' �(�� ec _ < r_-r7(_IeyZ�
Property Tax ID #:
Site Plan Name:
Project Name: _
l�icefzc � _
RECEIVED
JUL A 9 2021
Permitting Department
St. Lucie County
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New Electrical Meter SecbrSZl'ETVcrrical Meter (Affidavit required)
CONSTRUCTION INFORMATION ,
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
Z'Electric ✓41umbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: t �� Sq. Ft. of First Floor: _
Cost of Construction: $ -Ra, 2(0 0. Co -7 Utilities: _ Sewer ✓eptic
r
Building Height: l Q
OWNER/LESSEE.
e
Name -•F�� � �o c�
.
Name: � i:o�v►,erS � r.Sv rr1's
Company:. V\-O:r
Address: ra- OCR i I►'1
City: fi ICA- I -e- State: FL
Address:
Zip Code: 49 Z- Fax:
City: 1--e��S fie'`' State? FL -
Phone Phone No. 3-w - Lse _ /e_3gn n, r7.2.g6Q - zkrag,
Zip Code: 2.) CT7 WV Fax: `—
E-Mail:
Phone No
Fill in fee simple Title Holder on next p e ( if different
from the Owner listed above)
E-Mail SXv-/cmS
C
State or County License C' C-)tS-69/
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.
i
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Z Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: jfLNot 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 your Notice of Commencement.
\L�A ul� vulc
Signature of Owner/ Less ee/C for as Agent for Owner
STATE OF FLORIDA
COUNTY OF LA -E
Sworn to (or affirmed and subscribed before me of X Physical Presence or Online Notarization
this -7dayof O(- 20ZI by
"'eJL--_ ra (h(ltilrc"22
Name of person making statement.
Personally Known K OR Produced Identification
Type of Identification Produced
(Synature of Nary Public- State of Florida )
Commission No. GG cp/(� (Seal) % TIMOTHY J. KIRTON
;=o,P 9,,= State of Florida -Notary Public
Commission # GG 155610
My Commission Expires
October 29, 2021
REVIEWS 'I FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
SUPERVISREVIEWOR I RE EW LANS I VEGETATIEV EWON I SEATURTREV EWLE I MEEWVE