HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST.BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ��j /yy 2 Permit Number: 1 U/
RECEIVED
`U� d�G�I1G AUG 3 0 2021
St.Lucie County
Building Permit Application Permittinq
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)4624553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROP...OSED,'I IVIPROVEMENT'LOCAT'ION
Z, �S S � LL
Address: c-c-�-z� ��1v
Property Tax ID#: -L �d 2'r d Lot NoG�' �3
Site Plan Name:L c�-S/� CG-.�✓t 01^ C C� we2 j Block No.
Project Name:
DETAILED DESCRIPTIONzOF WORK
New Electrical Meter Second Electrical Meter (Affidavit required)
},CSTRUCTION I'N'FOR.NIATION ON
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 _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ ZT U U. Utilities: —Sewer —Septic Building'Height:
OWNER/LESSEE CONTRACTOR:'
Name �' "VL C'— Name: ��-
Address:- ��o S/. L r. is'1v J Company: �n ��..v /�/e -'�Gus fizu c�,°.,�
City: —_r'��2 c -Z State: / Address:Zip Code:Code: Fax: City: ZE�P)2 c—t State:" I
Phone No. E- Zip Code: 3/-/y Fax:
Mail: Phone No 7 7 Z- ' -2 Z
Fill in fee simple Title Holder on next page(if different E-Mail c' GI
from the Owner listed above) State or County License 'f
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 CONSTl2UCT[ONi,LIENGLAW INFuORMATIOIV
,
DESIGNER NGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: e -7, S'�� /l ame:
Address: ozJ , - , Address:
City: "ems s7 [ u« State: City: State:
Zip: y 'Phone 17 7 z_ - p S• , 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.
Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORID
COUNTY OFF WC_U
Sworn to or affir ed)and subs ribed bef re me ofhysical Presence or Online Notarization
this+�ay of 20�by
Name of person making statement.
P rsonally Known OR Produced Identification �����\\`EY 1M'P/N
y e of Identification Produced Q ;M''`ssio !frS+70i���
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J 0 i
( ignature of Notary P M
ic-State of Florida) _ : ••
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