HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �I Q ri ^ I
Date: Z%' 2-1 Pe7P'Number: \/1
e.IP-r,1 # 2011 02-07
RECEIVED
Building Permit Application JUL 2 8 2021
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
St Lucie County
'Permittinq
Address: 5 *3 7 7-
Property Tax ID #: yp 7 - N r 60 LO- 0 00 - (P Lot No.
Site Plan Name:
Project Name: A (Yl Pmo 1 v i
Block No.
onc- Aah_ fiL.. has j-W Gto$Ink iyi,je ay.a ,- keyed loc�gb�` 1a7C� ��Tt i5 o�1Swi'.s
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit -check all that apply:
(Affidavit required)
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total' Ft of Construction: 17 Q�-i
Cost of Construction: $ 2. 3 5a
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
�,t,.
a,.S''' i"
F v r.'�, �, < r'u'Tni•tkra t�
h. WNERr' LESSEE,v�QIVTRACTOR
t'�C*1' 9ry
t�:.�.y N4 ,d1i ;.,.'�'• -,� c.sd �rG.J1!2}lir� �,�,ro4a �ii67 . �i�'n .VI �L
y_50F;n.e
! f Y lrypA F ! N'S YM?rat f 'X�4 ff.�B t' 7N{ S e t�j *.fr
,`GQ,_dn .. Ctr. k
Name JEnn., Sgur•u
Name:
Address: S3 7`L % rt,_ '7 �p 7r j
Company: Shy N n Otis) r.�� o�ti C!� rP•
City: t�-C'c State:
Address: k5s S Pk Sv
Zip Code: MN t5l Fax: `
City: n kee AM 6 z — State: d' �
Phone No.
Zip Code: 2M 73 Fax:
Phone No S96-U47-1/297
E-Mail:
Fill in fee simple Title Holder on next page ( if different
E-Mail�-
State or County License �,& CSC-125 yF(31
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is requ
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENG
ER:
— Not Applicable
MORTGAGE C MPANY: _ Not Applicable
Name:
Name:
Address:
\
Address:
City:
State:
City: State:
Zip:
Phone
Zip: Phone:
FEE SIMPLE TITLE HOLD :
_ 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 inoicaiea.
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 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 1 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
,++tiof�ro Pr%m nant-inq wnrk nr rPrnrding vour Notice of Commencement.
...�...........,..........,....
Owl
.._... _ _...... -
- -
Signature of Owner/ Less
as Agent for Owner
ignature of Contractor/
STATE OF FLOR! A
!)ctor
STATE OF FLORID
COUNTY OF
COUNTY OF
Swo to (or affirmed) and subscribed before me of
P ys��t Prese or Online Notarization
Swo to (or affirmed) and subscribed before me of
cat Prese or Online Notarization
thi `clay f
dcy_�ko_
2020 b
thi of 2020 y
'U
Name of person making statement.
Name of person making st ement.
Produced Identification
Personally Known v
OR Produced Identification
Personally Known OR
Type of Identification
Z
Type of Identification
Produced
Produced
isa6bJ
(Signaturgl,,
0
(Signature of - F
Notary Public State of Florida
df �4r Notary Public Statqq f FI da
Commission No�
Samuel J Vuleraeal).
GGG
Commission No. Sam I J Vuletat�ea1�y
mmission 9099871
Expires 09/03/2023
My Commission GG 909871'
ti� Expires
?a OW0312023
REVIEWS FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
e
tcev. S/ o/ 2_u