HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO -MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:% '% Oo2,(a
•
Building. Permit App[ica
Planning and Developmentserviees
Building and Code Regulation Division Commerdial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (712) 462-1578
RECEIVED
tion JUL' 0 9 2021
Permitting DepartrAent
Residential' Luc°u"tv
PERMIT APPLICATION FOR:
PR QPOSED-IMPROVEMENT LOCATION:
Address:yr
Property Tax lD'#:ISO
/- S-oo Lot No.�_
Site Plan Name: Block No.
Project Name:
DEIAILED:.DESCRIPTION OF WORK:
P
New Electrical Meter WA Second Electrical Meter Ali+
L.SON$T.F�UCTIION INFORMATION:
Additional work to be performed under this permit- check all that apply.
_Mechanical _ Gas Tank Gas Piping _Shutters _ Windows/.Doors _Pond
Electric _ Plumbing t� —Sprinklers _ Generator Roof Pitch.
Total-Sq. Ft of Construction: O_ O 7 Sq. Ft. of Rrst•Floor:
Cost of Construction: $ lrllp . Utilities: —Sewer —Septic Building Height:
OWN ER%LESSEE:
CONTRALTOR:
Name
Address:y/s✓Ji�Xp(� L&
p
Name.
•
e4Z t
.Company:
City: -State: l
Address.*gkr�. 9a�� 1f -•A o f
Zip Code: .07,1 / Fax:
City: �� $�`� ,� State G
Phone No. 6 yea 9'
Zip Code: L!WW Fax:
E-Mail: /�oZ %r. IV
Phone'No{,z7,�) ��/o,%'o$S'� 7
Fill In fee simple Title Holder an next page (if different
E-Mail Ji b C ey1 s t" ® QeWI4;z > COWI
from the Owner listed above)
-�
State or County License
If value of construction is 21:nn ..,.......a - ne'"J%.,..—..
.... v. w.wuc,wcu,cua,a ioywCu.
If value of HAVC is $7,500 or more, a itECORDED. Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
City:
zip.,
Not Applicable MORTGAGE COMPANY: Not Applicable
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip. Phone:
Name:
Address:
city: State:
Zip: Phone:
Applicable
Name:
Address:
city:
Zip: Phone!
OWNER/ CONTRACrOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certffy that no work or installation has commenced prior to the issuance of a permit
St. Lucie County makes no representation that }s granting a permit will authorize the permit holder to build the subject Structure
which is in con"iiict with an x ppticable Nome Owners Assocation rules, bylaws or and covenants that may restrict or prohibit such
structure. Please rnnsultwrt�i your Home Owners Assoc}anon°and reviewyour deed for any restrictions which may apply.
In consideration of the granting of this requested permit,) do hereby agree that 1 will, in all respects, perform the work
In accordance with the approved plans, the Florida Suilding;Codes and st. Lucie County Amendments.
The fal{owing bu}Id}ng an
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
WAR. NING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice fnr
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 fitinancing, consult
with lender gran Attornev befora
----- - ri4ontractor as entfor owner
STATE OF FLORIDA 0 , � COUNTYOF u
rto (or affirmed) and subscribed before me of
sical PreSQnce or Online Notarization
this day of 20A by
Name of p rsbn m �statiment
Personally Known OR Produced Identification
Type of identification
Produced
N -
Syr P1
,� NOWY PUNIC Stets Of
Commission No. aP `E' Bunme MOM Woods
�I)My Commmmon HH 0
Dill Expires 0910712024
BONDING COMPANY:
STATE OF FLORIDA 0 � L u �o
COUNTY OF J
Sworn to (or affirmed) and subscribed before me of
_Lopbvslcal Pr-esce or Online Notarization
this iS day of 202 by
Name of peridn—m—a—k"j6Gtement.
Personally Known OR Produced identification
Type of Identification
Produced
of Notary Public sta o� da �, Not Stab Of F,
N (� �1(? ?�' aunme Meffm w�oreti
a 1 / 6 (�missial "03G
V 08107/2024
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