HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dater -'m z.1 Permit Number:
RECEIVED
Q >t c Q c Do tt == Building Permit Appl !cation AUG 31 2021
`. St,Lucie County i
Planning and Development Services., � ��. :c•:;=,`"'-<•--,-•_,-�_. •
Building and Code Regulation;Div''ision {;:, f Corrirnercial Residential Q'
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2300 Virginia Avenue, Fort'Pier`ce-FL'34982"
Phone: (772)4621553 Fax,Y..(772)462 1578'�` CBDG••Funding ;
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT. CATION: ;r .
Address: r — •
Property Tax ID#: �� 1 C>0� ""-`'d6� Lot o. _ y
2-4724
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Site Plan Name: �� 1S S - Block No. ?
Projecf-Name: t..�,c��,a��.L.. '►�� "''
d.
DETAILED DESCRIPTION OF WORK: ! ;
R ti V Y:
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION: I xhn
Additional work to be performed under this permit-check all that apply:
Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors i —Pond
p
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_Electric _Plumbing _Sprinklers _Generat . V Roof / Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: 9 „�
Cost of Construction: $ 0 �d Utilities: _Sewer _Septic Building Height:.
g
OWNER/LESSEE: CONTRACTOR:
Name Name: %
Address: ` .CA �� D Company:
City �_ T��,3 State: Address: S _ . '
Zip Code-3A Fax:
Phone NO.�I�Z"';✓ -7-7 E- Zip Code: Fax:
Mail: i 9> Phone No-1'77�� ���► �i j -- - +
Fill in fee simple Title o e"r b--n nex?p `(if cN'renty E-Mail
from the Owner listed above) State or Cour.,y License
a � •„
--------- I':;'
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, , a;
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: .
DESIGNER/ENGINEER: _Not Applicable MORTGAGE -OMPANY: _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 jndicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
1
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 'or any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I to•.I,in all respects,perform the work °
in accordance with the approved plans,the Florida Building Codes and St.Lucie Col•ity 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-wrier/ ess a/Contra for as Agent for Owner
4`
STATE OF FLORIDA
COUNTY OF Ir. --Uz:��
Sworn to(or affirmed)and subscribed before me of Physical Presencr or Online Notarization
this3�day of V� 2(��by
Jr
Name of person making state ent.
Personally Known OR Produced Identification
Type of Identification Produced ,..
(Signature of Nota blic-State of Florida)
Commission Not"dtm
VE.NS
NNAstate of Florida
lic• 086359sion HH 28,2025.Expires Notary Assn.National
Bonded--- - _
REVIEWS FRONT I G SUPERVISOR PLANS VE:ETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW r,;r
DATE
RECEIVED = ''
DATE t
COMPLETED f
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