HomeMy WebLinkAboutBuilding Permit Application s _
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:\b��`�, Permit Number: ZL*X
85U]LU `CE � RECEIVED
OCT
Building g Permit Application o 4 2021
~~ St.Lucie Cownty
Planning and Development Services f�®fifiitflHN
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 CBDG Funding
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PERMIT APPLICATION FOR:
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4_)Tr 4 1....,'�. � tf< a 4
PROPOSED IMPROVEMENT LQCATIOf� i � �' p �`��`�` � �
Address: /�r/�� rJ. (/.s HWZI. f�eW ,..f./. JW61C- G- =3Yc/�o2
Property Tax lD#: `11�1�5b�"' Salo. a��'" Lot No.
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Site Plan Name: Block No.
Project Name: Cl-14NC E Q f/T
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w14Al "A 7-alV 14 60645 A%A:L A, C 5Y V03
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1 14 jet)rr3/61�64
New Electrical Meter Second Electrical Meter (Affidavit required)
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CONSTaUCTlOI� INFORMh►TION
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Addition work to be performed under this permit—check all that apply:
' echanical —Gas Tank —Gas Piping —Shutters —Windows/Doors —Pond
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Electric —Plumbing —Sprinklers —Generator —Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
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Cost of Construction:$ ���� Utilities: _Sewer _Septic Building Height:
OWhI�Rf LESSEE'
Name ri 19,�4 04A 1zle, Name: %Vf}Tl-"AM Q j N16e I19
Address: Company: AgeT114 AIC S. WEXTIAJ6 &Z--
City: J State: Address: /�,qD --56V 012 ��.
Zip Code: `J7i Fax: City: g047- S T L UC/E State:-1671—
Phone No. 2�� �7z)-Vw E- Zip Code: Fax:
Mail: Phone No -7 72 — 3a,--2 Q
Fill in fee simple Title Holder on next page(if different E-Mail _564,b4n0W4110N,&C11.Y70J1 M111
from the Owner listed above) State or County License 12A13 7j`!7G
5L . l 6
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.
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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 p I rmit 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 I
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 anothi r 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 ofICommencement.
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ig ture o wner/Lessee/Contractor as Agent for Owner
STATE OF
COUNTY OFORIDA / oC-y j ,C/
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Sworn t (or affirmed)and subscribed before me of � Physical Presence or Online Notarization
this day of Z2o7_ by
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Name of person making statement.
Personally Known A�R Produced Identification
Type of Ident' ation Pro -
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(Sig 4 a Public-'State of Florida)
Commi sion No. ROS000.GONZALEZ
`� r MY COMMISSION#GG349505
"Q wolo� EXPIRES:July 01,2023
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
rev 7,2072-1
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