HomeMy WebLinkAboutBuilding Permit Application-All APPLICABLE INFO MUST BE'CO14LETED FOR APPLICATION TO BE ACCEPTED
Date: (� Permit Number: '�a1
(]]!j(�� RECEIVED
AUG 27 2021
p? Building Permit Application
�,ihm�i4 Co�aYttll
Planning and Development Services prrl�lfl�
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 fMPROVEMENT LOCATION:
Address: 14 3 7 :5 �Eet t, gLe.'e P0 t+ Sc�," h� �. VC-1 C �j 8
Property Tax ID #: 9 a•a4—S01 0OS(A-y D0 Lot No.�O
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK
3000 PD / ' „6el- ter, x
"?o X to C)40 iso Hof
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
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
Generator
Sq. Ft. of First -Floor:
Windows/Doors _ Pond
Roof Pitch
Utilities: -Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR.
Name +o LA
Name:
Company:
Address: f '; ? P p Oq
City: " �� rniti'r' �rJ� /. a State:
Address:
City: State:
Zip Coder Y 9 X �7 Fax:
Phone No.� �i�/ G`aC� Z / E-
Zip Code: Fax:
Mail: 3 �ola o_s,4 199y N A El ,. m e1
Fill in fee simple Title Holder on next page (if different
Phone No
E-Mail
State 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.
,SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Not Applicable
MORTGAGE COMPANY:
of Applicable
Name:
Name:
Address:
Address:
City:
State:
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.
Luci County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
w' ender, r an attorne before mencin work or recordingour Notice of Commencement.
ev
Si ature of Owner a see/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF �
Swc�� (or affir d) and subscribed befsr� me of Physical Presence or Online
thisooll day of C\ . 2 by
Notarization
W Y •
Name of person making stateme t. /
Personally Known OR Prod Ide tification
Type of Identifi tion Produced
i
(Signature of Notary Pu lic- State of Florida)
��������KAREN S.NIELSENCommission
No. SealF�Y"�e%()��;StateofFlorida-NotaryPublicCommission#GG207484
F
FOFFAO��MYCommissionExpires
��������' June 12, 2022
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