HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: \-a' Permit Number:��4��a�5�
�C�aLIL RECEIVED
Building Permit ApplicationJUL 0 2 2021
Planning and Development Services St, Lucie County
Building and Code Regulation Division Commercial Resider irittinq X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address:
L
Y,
Property Tax ID #: r 3 '�7-® 501 - 1-7,Q rX Lot No. E_
Site Plan Name: & e &V—AI r'AJ Arzw C Block No.
Project Name: e �C7/7' ''i C `r �r e
DETAILED DESCRIPTION OF WORK:.
4
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
Mechanical
_ Electric
Gas Tank
Plumbing
_ Gas Piping
_ Sprinklers
Total Sq. Ft of Construction.. T ze2 C7
Cost of Construction: $ % ,5, aU,C?
_ Shutters _ Windows/Doors _ Pond
Generator
Sq. Ft. of First Floor:
Roof Pitch
Utilities: —Sewer _Septic Building Height: f
OWNER/LESSEE:
CONTRACTOR:
Name SC* Q PA,a
a•
Z=
Name:
Address:
City: 6 rxe
Zip Code: 3q Fax:
Phone No. 7% 9613
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State:
Company:
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail: tJ L',-Z-VA) e l4g,0 .4J LV
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Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is S7.500 or more. a RECORDED Notice of Commencement is reauired.
v
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Address:
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 attorney before commencing work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OFF /J V)
Sworn to (or affirm d) a d subscribed before me of �/Physical Presence or Online Notarization
this � day o 20OU by
Name of person making statement.
Personally Known v OR Produced. Identification
Type of Identification Produced
(Signature of Notary Public -State of Florida )
Commission No.
REVIEWS I FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
COMPLETED
f •
•. DIANE COTE /
i. Notary Public - State of Florida `
Commission N GG 961089
My Comm. Expires uar 14, 2024�
Bonded through National Notary Assn,
SUPERVISREVIEWOR I REVIEW NS I VEGETATIEV EWON I SEATURTEV EWLE I M EVIEWVE