HomeMy WebLinkAboutBuilding Permit Pkg All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1 )�
Date: 1 I Permit Number:
V�
RECEIVED
OCT 062021
° `;> ° ✓° Building Permit Application
St.Lucie County
Planning and Development Services Perm' ' 9
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 IMPROVEMENT LOCATION „n t
Address:
Property Tax ID#:I k X O1 3Z d Lot No.7
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF-WORK 4
New Electrical Meter Second Electrical Meter (Affidavit required)
CO;NSTRUCTtON INFORMATION
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: Sq. Ft.of First Floor:
Cost of Construction:$ ���_ Utilities: —Sewer _Septic Building Height:
OWNER%LESSEE CONTRACTOR
Name Name:_:Yucsn -C
Address: Company: C-cr-me-
City: --V I�Iexcir_ Stater Address: G�,DL, 10� As r-
Zip Code: Fax: City: 1J=32:) C.,('�l State: );71
Phone No. E- Zip Code: Fax:
Fax:
Mail: Phone No uqn LA t;:�S._
Fill in fee simple Title Holder on next page(if different E-Mail C t_�
from the Owner listed above) State or County License
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 LA ON
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not 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.
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 our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF cz�-V. f \ ).QAf: _
Sworn to(or affirmed and subscribed before me of v Physical Presence or Online Notarization
this_L day of eY 20_Zk by
t
Name of person making statement.
Personally Known A.ZOR Produced Identification
Type of I tifica ' n Prod d
-- w
(Signatur of o Public-State of Florida)
E
CRISTINAONTIVEROS
Commission No. (Seal) MY COMMISSION#HH103629
EXPIRES:March 11,2025
Bonded Thru Notary Public Underwdtara
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev
RECEIVED
OCT 0 6 2021
BROOKUNE AVENUE St.Lucie County
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7107 BROOKLINE AVENUE Cert i I ied to: Jeff Womer
SCALE:1"=30' Atlantic Land Designs VanDyk Mortgage Corp.
6 t. Lucie Title Services, Inc..
•8 27 t3 of the Treasure Coast. LB748 G National Title Insurance Co.
DATE
• / / 7w ttE Jensen Beach Blyd. Jensen Beach. FL 34957 1 hereby certify that the survey sha*n hereon is true end correct
ne►A,1 : AWP Mailing Address: and is based on aetual measeurements token in the lield. This
�u'"`^^�R''11 P.O.Box 1421 Jensen Beach,FL$4958 survey meets the�inimm Technical Standards of Chapter 5J-17`x e
Florida administrative code. s at,rr `Ro
2013-0680 ALD5M3@gmail.com (772)3984290 4?
DATE: REVISIONS James A °D`**s4—""'—A
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Wbami A.Cesmir,D=ltlm8c
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LAST FIELD DATE:8/27/13
NOT VAUDWITHOUTAN AUTHENTICATED ELECTRONIC t0Rl9F' s
SIGNATURE AND AUTHENTICATED ELECTRONIC SEAL a SCR.