HomeMy WebLinkAboutBUILDIDING PERMIT APPLICATIONAll APPLICAB IN 0 MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED j Q� j
Date: �2/ Permit Number: �l J `R
RECEIVED
�I r CUE
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SEP 0 0 2021
1.
Building Permit Application at,6►woofmriw
Permitting
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` I'MPROVE ME 4 LOCATION.'
Address: 9h U S dcfln i)l- 04' 4-4 7
Property Tax ID #: K02- - 410 - 0/'1% - 000- 60 Lot No.
Site Plan Name: Block No.
Project Name: claw-- '/- 04 f�'no'le✓@Z /P-R k/7 CG
RETAILED DESC1Rf ,TION.O.F WORK:
aA ( Z/ ) WI —~.l W/
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION,INFORIVIATION
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction:
Cost of Construction: $ -X� .2,5"/ • 9?
Sq. Ft. of First Floor: _
Utilities: —Sewer —Septic
Building Height:
Pond
Pitch
OWNER%LESS€E
yCONTRACTORi
Name .mod
! Z.
Name: n►Gi a(D
2
Address: 7114, C/&e4�111t_
Company: /COn
Address:
City: L4&4 up
Zip Code: 'Yl1 7 Fax:
Phone No.
State: AL
E-
City: '40V4 l e_446
Zip Code: 3 3Y70 Fax:
Phone No 639L 32!V (WX2
State.
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail �99/X�y Old/CA'J�l/Dt/D'
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State or County License Cyr /5L(.0/(o
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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.
I' SUPPLEMENTAL, CONSTRUCTION LIEN, LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
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 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 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 commencing work or recording vour Notice of Commencement.
Signature of Owner/ Lessee/Con a or as Agent for Owner
STATE OF FLORIDA
COUNTY OF - I m 6.0a'o-k
Sworn to (or affirmed) and subscribed before me of 'X' Physical Presence or Online Notarization
this _LL day of 20_4_� by
EA(1r2A1
Name of person making statement.
Personally Known )� OR Produced Identification
Type of Identification Produced
(Signature of of c Florid
c state of Florida
Commission No. D (Seal)Goykhman
MERE]
sion GG 201740
312022
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Rev 5/LU/L1