HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a/ a��j �ECEI�D Permit Number: �1 l-V
�7 2021
0 Wuje Uoun�f
V h ° ° r, P1 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: 10:oc &
Property Tax ID#: ��Ioo'�- (010 - 000 -a. Lot No. 3C7
Site Plan Name:3 e-3 Block No. gel
Project Name:
DETAILED DESCRIPTION OF WORK:
- a -
New Electrical-Meter ✓ Second Electrical Meter (Affidavit required)"
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all,that apply:
"Electric
_Gas Tank _Gas Piping Shutters +Windows/Doors _Pond
/'Electric ✓Plumbing _Sprinklers _Generator ,Roof Pitch
Total Sq. Ft of Construction: C2 9 Sq. Ft. of First Floor:
Cost of Construction: $9. ��-4_v_ Utilities: —Sewer Septic Building Height: S r
OWNERAESSEE: CONTRACTO
Name Name:
Address: 157st a Company: 40
City: FC-1 (��� State: R. Address: /03 0 u;��4F_Ckr �Se 109
Zip Code: Fax: l� City: - �.�c.�� Stater
Phone No. Zip Code: Fax:
E-Mail: Phone No -
Fill in fee simple Title Holder on next page(if different E-Mail 4 ® om
from the Owner listed above) State or County License CSC_ /a�3110
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 LIEN LAW INFORMATION.
DESIGNER/ENGINEER: _Not Applicable MORTGA COMPANY: _Not Applicable
Name: c>omec�. fit- �FC.4�J w t or€,�S��S Name:
Address: (3\„a nQ6 Address: (jS 1 /
City: State: F�' City: Qcr� 2'�- State:
Zip: '�Cp-q Phone -071a Zip: '449ya Phone: 1)9a- Aa-o_ C3'N
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.
Signs a of Owner/Lessee/Contra as Agent for Owner
STATE OF FLO 1
COUNTY OF
Sworn to(or affirmed)and subscribed before me of ✓ Physical Presence or Online Notarization
this a day of _ 20LL by
Name of person making st ent.
otJs.Pu% DEBORAH STEVENS
Personally Known OR Produced Identification = Commtsslon#HH 154345
Type of Identification-Produced ce Expires August 11,2025
.. 9rFpFF�OQ\ Bonded Tlw Budget NotarySerykes
(Signature of Notary Public-State.of Florida.)
Commission No. 17 / (Seal) a°,,,%P:k DEBORAH STEVENS
Con dsslon#HH 15"
* \dam Expires August 11,2025
Be WT=BudgetNotarySentes
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER - REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
iev5/20/21