HomeMy WebLinkAboutBuilding Permit ApplicationAlt APPLMABLE INFO- MUST BE COMPLETED- FOR APPLICATION TO- BE ACCEPTED
Date: pl c Permit Number:
RECEIVED
p;.. ° _ • , ° - Building Permit A atlOn JUN 0 2.2021
Planning and Development Sppervices Permitting Department
Building and Code Regulation Division Commercial Residential St. Lucie County
23DD Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Address: `Z .
Property Tax ID #:
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
E
`h6- o w7e s
New Electrical Meter Second Electrica
CONSTRUCTION INFORMATION:
Additi9nal work to be performed under this permit —check all that apply:
°_/MQchanical _ Gas Tank _ Gas Piping _ Shutters
_Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: :5.QOo S 6r Sq. Ft. of First Floor:
Cost of Construction: $ 110, C200 Utilities: —Sewer _Septic Building Height:
Lot No.
Block No.
s
Windows/Doors _ Pond
_ Roof Pitch
OWNER/LESSEE:
CONTRACTOR:
Name ® {r'r 00
Name:
Address: �T U
Company: Y90AL
City: V' State
Address:
Zip Code: g qqi" Fax:
City: 0; 0State: 6�
Phone No. zz— 0T—/0`l
Zip Code: 3 NO fax:
E-Mail:
Phone No 77172
Fill in fee simple Title Holder on next page (if different
E-Mail llj B�
from the Owner listed above)
State or Coun y 1 icense
It value of construction Is 25OU 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:
DESIGNEF,LXNGINFJER, (
_ Not Applicable
MORTGAGE COMPANY: -Not Applicable
Name: S
19
Name:
Address:
Address:
City:
Zip: ffl Phone
�ate:/-t/,�-City:
�Zip:
State:
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 perm -it. -
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
witbJ"d.er.or an .attorn.ev .before .commen.cinia work .or re.cordi.ng vo.ur N.Qtice .of .Com.m.e.ncem.ent.
Sig�fure%FL
ne Lessgb/ o�ractor Agent for Owner Signature of C�6ZrA
tor/I�icens¢�Holder
j�J
STATE OA h'STATE OF FL
COUNTY OF l )J - LU� l � COUNTY OF � LI 10j1L
Sto (or affirmed) and subscribed before me of
rysical Pre ence or Online Notarization
this day of N`2_ 2021 by
Name of person making statemEnt.
Personally Known V OR Produced Identification
Type of Identification
of Notary Public- State of Florida )
Commission No. a`"n'J'd'o KAREN 9( ,-L�� SEN
r -State of Florida -Notary Publi
Commission # GG 207484
o,FOFFo�, y UOMMission Expires
REVIEWS 20
COUNTER REVIEW
DATE
RECEIVED
1L���
Sw�to (or affirmed) and subscribed before me of
Physical Presepce or Online Notarization
this � day of JL I L I E 0 202Q by
<==—I\
Name of person rAaking state nt.
Personally Known OR Produced Identification
Type of Identification
Produced n
(Signature of Notary Public- State of Florida )
Commission- No:
R IPLANS I VEGNWR
REVIEW REVIEW
KAREN SMfg
fate of Florida -Notary Pub
Commission # rn
"y commission Expires
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