HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: —1 - Z I - Z OZ 1 Permit Number:
ST LuCIE �•
F L "O R •1 D A +-
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION
n.
RECEIVED
JUL 2 7 2021
St. Lwpla County
Permitting
Residential ✓✓/
Address: 14 1-1 N W W i ►n+e,v S C✓.0 K 12 of 1�0.� IM C i -i-`t , FL 3499 O
Property Tax ID #: 44 Z (o' $ 2 5 - 001 2 - 0O - a Lot No._r r
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:: .
P22-2vv1 bv.e. 6 l e X i 5+i via I bo r i n i .f s 1- b aL.+ In w o o w,.. Iw A g-1-�r %a�r-I,. I
aou6i v�.c.-1'yio.r, I cw ,na 0t�ra.l I ; dd snA►',, +wb a,.•►al -1-0� Le+-;
Add 1,1aIl and Jcmv :&v 62cfrooinn ; blew 12l%&vy'1✓i v,g -Co ✓ S i K•
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION. IN:FOR'MATION
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
�ectric "41umbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: 2.1 542 Sq. Ft. of First Floor: 2 5 42
Cost of Construction: $ �`�� Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: .:.
CONTRACTOR:
Name Ae r 1-.
Al ame:
Company: Q I�J(A5 In
Address: 31 l S-b►uw�t W au
City: S-}'1A�L-r�- State: FG.
Address: 2�-E �fIOY�%2C'
Zip Code: 3�l 114, Fax: 1-12.-3Z¢ - 85 7$
it'S U�G�-� State:�(..�
Phone No. -1-1 Z - (o Z(v - 3 t "7 R
ip Code: �LEQC% Fax:
E-Mail: ie [�(ibeL4:g10 Aide rrm&p.co�
hone No '32q- a 2 7
Fill in fee simple Title Holder on next page ( if different
-Mail �'
► tr (Ou I r
r`� , C
S ate or County License
from the Owner listed, above)
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.
SUPPI:EMENTAL CONSTRUCTION ALIEN„ LAW INFORMATION
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
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 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 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 job " efore the first inspection. If you intend to obtain financing, consult
with lender or an attoph-eV befoveloi pig work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA f/I/►1 ,.
COUNTY OF / I' f � ? 4 YPhysical
Sworn to (or affirme) nd subscribed before me of Presence or Online Notarization
this�dayof 20,)_L by
�n t
Name of person makiA statement.
CHRISTINA FORTIN
,0 Notary Public - State of Florida
Personally own OR Produced Identification �`"o� Commission GG 937464
Type of I ent IcatiOn r Ce '?oF� My Comm. Expires Dec 5, 2023
Bonded through National Notary Assn.
(Signatu Notary Public- State of Florida )
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED