HomeMy WebLinkAboutBUILDING PERMIT APPLICATION r
All-APPLICABLE INFO MUST B COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Ul Permit Number:
SEP 0 2 2021
Building Permit Application Pef�►itifl�
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 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
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Address: �� �a�+✓ D/L �ey � L -W '91
Property Tax ID#: ~�D D � ,� Lot No.. 7
Site Plan Name: C_ p C L v v Spy, Block No.$_
Project Name aew pe b l
DETAILED DESCRIPTION OF WORK:
2UA O V 1 w S
n , C AX s
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:. 11
j 4.
Additional work to be performed under this permit—check all that apply:
_Mechanical —Gas Tank _Gas Piping _Shutters _Windows/Doors _Pond
_Electric _Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: 3'Vy C' Sq. Ft.of First Floor: !�AC9 O—C-:)
Cost of Construction:$ Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE; CONTRA,.TOR:
Name .. e` 4014-1 Name: D!!Fig. Pam(
Address: [ O Co Company: Vak 4 ei zp K M6`
City: iL I-doC State:Lw Address: s `'
Zip Code:3 Fax: City:�-ePral GGr!eA State:e�
Phone No. E- Zip Code: Fax:
Mail: Phone No 4(o �_3 O
Fill in fee simple Title Holder on next page(if different E-Mail Gcev r -'Ovt D G.
from the Owner listed above) State or County Licensee/3i2.�I
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SlJ 6
If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required. I
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SUPPLEMENTAL CONSTRUCTION LIEN 'LAW fNFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY. Not Applicable
Name: Name:
Address: Address:
City: 1J State: City: All State:
-Zip: Phon Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City: VL
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do thew rk 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 prope y.A Notice of Commencement must be recorded in the public records of St.
Lucie Count and posted o e jobsite before the first inspection. If you intend to obtain financing, consult
with lend r a attorn efore commencingwork or recordingour Notice of Commencement.
Signature wn r/Lessee/Contractor as Agent for Owner
STATE OF FLOR
COUNTY OF 1'VI Azwk"
Sworn to(or affirmed)and subsc 'bed before me of Physical Presence or Online Notarization
this Wda=, :L1z
W by
sC e&
Name of person making statement.
Personally Known OR Pr c I e ' ication
Type of Identification Produced
(Signature of Notary Public-State of Florid
/ v►r Pt Notary Public State of Florida
Commission No. ✓ (Seal) ; 4. Erica Lee
y- � My Commission GG 959669
'+yorao� Expires 0211812024
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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