HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
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Q L C E•„ E c R, Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 y^i^iu
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCA ION:
Address: d-1110 to SI ST S•4. 9 Pkrm,
Property Tax ID #: 14 ` 10 1 — 00 i 6 " 0C) 0 Lot No.
Site Plan Name: G..r-AAQh flC Block No. F
Project Name:
DETAILED DESCRIPTION OF WORK:
ew► o_ cc ee, n'GIr I a eio✓'
GAG s
New Electrical Meter Second Electrical Meter (Affidavit required)
[CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
_-Mechanical s Gas Tank —Gas Piping _ Shutters Windows/Doors Po,,d
_ Electric _ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
Sprinklers
Generator Roof Pitch
Sq. Ft. of First Floor: �y60
Utilities: _ Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Orr rrr.
Name: Vui d C
Address: `1/ O N. .s
Company: C-
Address: �' )-C)0Cf S� �Gi iS%H S _
City: V(2.. State: F%
Gi
Zip Code: 3yQ 9 Fax:
Phone No
City: F.1, ICr Cei L State: r �.
Zip .ode: g Fax:
Phone No. 7 % 2 . %Ci C) 3 E-
Mail: rier i1"t U
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail�cwts kio C/ f0 bir f r_ . CO kvi
State or County License �.4 e ts'�L
If value of construction is 2500 or more, a RECORDED Notice of Commencement is requireo.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: I
DESIGNER/ENGINEER:
Name: _
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
Not Applicable
State:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
Citv:
Zip: Phone:
Not Applicable
State:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
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 conflicts with an 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 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 recording vour Notice of Commencement.
l
Signature o wner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF 4y1Qr�� '^
Sworn to (or affirm )and subscribed before me of /�
Physical Presence or Online Notarization
this day of 20 by Oa r Lj �7
Name of person making statement.
X_
Personally Known OR Produced Identification
Type of Identification Produced_T� /
(Signature of Notary Public- State of Florida)
;;^tav' tr-,,, TERESABENNIGAN
G 6 S
Commission No. teal)
Notary Public - State ci Florida
Commissioc = GG 167257
�; �r ,�:' My Comm. Expires Dec 29 2021
led Vo oM Nanna Nc:-r., Assn
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Rev 5/20/21