HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 061 9, Z02.1 Permit Number:
0�v. RECEIVED
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' � SEP 08 2021
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BuildingPermit Application p p St.Lucie County
Planning and Development Services Permitting
Building and Code Regulation Division Commercial ✓ Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR: v .
`PRQPOSED IMPRPVEE,MENT LOCATION
Y
Address: r1� 0 ��� l�\cthNiAtl l �Oti^� GakkA Wc�& rl , 3495 Z
Property Tax ID 006 000 , I Lot No.
Site Plan Name: - _ Block No.
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Project Name: s1� G A S c S 52as
D�ET�AI'L"ED D'ES�CRIPT NW,ORKY�
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New Electrical Meter Second Electrical Meter (Affidavit required)
CO�NSTRUCTION IN'Ft�RMATIQ3N "
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Additio al work to be performed under this permit-check all that apply:
Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Pond
_Electric Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: -
Cost of Construction: $ (0 ID, 00 Utilities: —Sewer _Septic Building Height:
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®1NN;ER/LESSEE ' k ° CONTRACTOR:
Name Name:
Address: Company:P)QW'�S ✓bQ91LLC
City: \;)L"� State: ?1- Address: ( lid I OD& AQt
Zip Code: �3J 40- Fax: City: WfPi State:_VIL
Phone No. Qb 4_1:�$0- \\+z E- Zip Code: 33 Fax:
ti. Mail: D ,e, e.own Phone NoI- lv.'3��1 l
Fill in fee simple Title Holder on next page (if different E-MA®Ciy% &o 14te S�nU • LO&A
from the Owner listed above) State or County Licensee 1215
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.
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7PLEMENTALCQNSTFUCTION LIEN LAW,INORMATION
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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 conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict-or prohibit such
structure. Please consult with your Homeowners 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.
Si.gr&eKe of 0 er/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA COUNTY OF �CA{n bda61.
Sworn to(or affirmed) and subscribed before me of Physical Presence or Online Notarization
this$day of ,20Z=�by
IN
Name of person making statement.
Personally Known f7. 4—OR Produced Identification
Type of Identification Produced '- . 2d'
ii ` v
(Signature of Notary Public-State of Florida)
ot�er MANDRICAR P.MANGRA
Commission No.OLC �� Seal) .••••,
.� Commission N GG 341657
Expires October 4,2023
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev5/20/21