HomeMy WebLinkAboutculbertson building permAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
ClDate: " I h S (loz I Permit Number:
° a 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
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Lddress: LI (n I I f7),LCVir, hiln C)r Fo (-1Rrco -crr 3L+ctsA-7
Property Tax ID #: bLf 0 Z %chs i, I Zd 0(yJ % Lot No.
Site Plan Name:
Project Name: O U I h- ( { So (1
DETAILED DESCRIPTION OF WORK:
�Q Mx� CC'cj y J40 V4
w
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Block No.
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: d Sq. Ft. of First Floor: "J
Cost of Construction: $ (, DOO od Utilities: _Sewer _Septic Building Height: l�gk
OWNER/LESSEE:
CONTRACTOR:
Name W CtJfF G..t,11De✓tSar1
Name: "ef -i CLSCC
Address: 3*: Li(oil &Ch4rtaVL Dr-
Company: C6C05 f0olfW�ti H
S Z YX
City: 4:�;( +- 1 L4 C Q_ Stated-
Zip Code: 5'-t G B Z Fax:
Phone No.
Address: 9q 4 5w '55 m S
l-
City -Da Iyy1 C l
Zip Coder q 4 SZ Fax:
Phone No 777 - S Z'i`VO-1y
State: iL
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail IS c05 Yo0 tw f-e
I V fl r-r L
State or County License
13 2.7 -7
it vawe or construction is z5uu 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: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attornev before commencine work or recordine vour Notice of Commenrempnt.
as Agent for Owner
STATE OF FLORIDA G
COUNTY OF `, - [�, r (4
Sworn to (or affirmed) and subscribed before me of XPhysical Presence or _ Online Notarization
thi I-^ dayof 5109MV-r 2021 by
J,S oA4 CulYieyi
Name of person making statement.
Al
Personally Known X OR Produced Identification
(Signature of Notary etyblic- State of Florida )
Commission No. 44 (& 7 4Q Z (Seal)
REVIEWS
RECEIVED
FRONT I ZONING
COUNTER REVIEW
r NANCY HAGIBOO W
d' Notary Public
a o State of Florida
e COMMN HH167992
Nctte�� Expires8/23/2o2S
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