HomeMy WebLinkAboutBUILDING PERMIT APPLICATION - 166 SE ENTRADA AVENUE- 09-17-2021All APPLICCA��BLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `("f/1'1 2 1 Permit Number:
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Building Permit Application
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:
Address:10)(P 5E entC da (D,
Property Tax ID #: �Iq aM - WQ" -1 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
4.
ic)2 cM k l new QCAur-y- z - 6-E) -tcn iil See ' uol 6 Zw e lect-rs c.
hec te C Juir i CI P nh C t l 0MAX CN
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
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: 1 , 0122L,� Sq. Ft. of First Floor:
Cost of Construction: $ 4- 1 S , Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Namemrar�o i
Name
Company:�l`i�ICQJY1 ("li �I`iif'a 1flC,
Address: ?q�) ak LC'
City: + WG i , _ —State:
Zip Coder q <6 `_� Fax:
Phone Nol -14 - 8k 3LA q ( I G E-
Address: I Q } 7 bi I. tlyi�
City%f+ S} L,.1.. Qye State:
Zip Code:z Fax:
Phone Noll,�) • 131 2,-" CSC C2)
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License (\-RC �� l
It 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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: - x Not Applicable
Name:
Address:
City: State:
Zip: Phone —
MORTGAGE COMPANY: x Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable BONDING COMPANY. x Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
UWNLM/ 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 no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in
con t 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 jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording your Nptice of Commencement.
Signature of
as Agent for Owner
STATE OF FLORID
I
! Swor to (or affirmed) and subscribed before me of
r t' ;/P,ny sisal resentp or Online Notarization
.h s' I P
this day of �eD-H_ 2074by
Name of Pelson making statement.
Personally Known _—OR Produced Identification
Type of Iclent&ptior`A.��_
Produced "-.4
NOTARY
(seal)
Corrirr* GG298272
Signature of
STATE OF FLORII)CA-A.-
-
COUNTY .291
SworpAo (or affirmed) and subscribed before me Of
_V Ph sical Prese ce oc Online Nolarization
this day of 2202JF by
hu"M
Name ofpe Jon making statement.
Personally Known --OR Produced Identification
Type of Idenkab
Produced ZV
re of Notary Public- State
Comm M5 DN. (Seal)
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98277--
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Rev. 5ibi20