HomeMy WebLinkAboutBuilding PermitAll APDI irAw F ifurn Mi ICT RF rnmpi FTFn MR ADDI irATInN Tn RF ACCEPTED
Date: !yI 15 21
Permit Number: '
s' LLLL 6 LI qc f
Building Permit Application
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 IMPROVEMENT LOCATION:
Address: Z.OoC) -TA(4 ]Rd i?r7r4 r=l. 3q(I 5)_
Property Tax ID #: 34114 - 501 - o S1-:� 9� 5o -LA Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
_n. '3, art fro Cir_LErIC
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 _ Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ i 3 50
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name �P.,.v.�Sr1�1GJP�
Address: Zygc-) T',1 i cn Rri
Name: JQ�Yn-rs UJ06')LC r'S
Company: _� uSh x IN a('_
Address: 5q2Z NW Crrffh,,„ St
City: Pr A- S1 I _i )C 14 State:
Zip Code: 34 q%lp Fax:
Phone No --n-7- -Qq() -4�J 5
City: Poor SF Luc, a State: F--
Zip Code: 34� �r� Fax:
Phone No. 137-oc) E-
Mail: seJ vr,(, Q f P_nll�II�,�Ilr,l;fed
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail ' sl- r,
State or ounty 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 LAW INFORMATION:
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 your Notice of Commencement.
Si�g�' ature of 0 er/ Lessee/Contractor as Agent for Owner
STATE OF FLORID
COUNTY OF
Sworn to bef9L9
Physical Presence Online Notarization
(or affirmed) and subscribed me of or
this / -V8fay of 204y
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced/.
(Si n tureof Notary Public-Stat Florida)
BURFORD
Commission No. (Seal)
HEATHER Public
`io+►"rv��cia Notary
- 0 CC 183 es
ssion Exp
EL y 06, 2022
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