HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVED
_ O
"p Building Permit Application SEP 01 Z021
Planning and Development Services @I. well 9910ty
�eFrrIItEInO
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:
P'ROPOSED,I'MPROVEMENT LOCATION::
Address: 7 ) Z CCgtl ire A" al
PropertyTaxlD#: Z.3//-6D/JC:>OZV-000-0 LotNo.2%9T Z621
9,3d,3
Site Plan Name: J-450a Se /p A Block No. _3
Project Name: TuSoh
'DETAILED DESCRIPTION OF WORK:
2 11 X30AIenGlos rKela! buila/i�►� OA Aew GDtiGvcic, �wo IDx/O/
U>Ae-rete ONC lA I4e T/o^> 411c/ Dote in 14e- /etr No e*cfr,G acted
l ��� r0 �u r�.l, :►9 , I �XI a my►� o FTC.-� �,c� f o1 �� �-��rS V�-�Y1n i ILS. ,Cry' `� , r �-h� ck @ o�,� I�
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 r -I Roof Pitch
Total Sq. Ft of Construction: 3/ 30. S'O
Cost of Construction: $ J, / D 30? , c Utilities: —Sewer _Septic Building Height:
.OWNER/LESSEE:
CONTRACTOR:
Name raSoaSeI.94
Name:
Company:
Address:
Address: Z 1 L c koacl
City: )Co,, f gr e.,c e State: LL
Zip Code: 3 Y9 Yr Fax: 772206- 30Sq
City: State:
Phone No. ? ? Z- Z01-1 e7? E-
Zip Code: Fax:
Mail: S e /P AG i - e9 L olm
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail
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.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW IWORIVI'ATICIN:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citv:
Zip: Phone: _
_ Not Applicable
BONDING COMPANY:
Name:
Address:
Citv:
Zip: Phone:
Not Applicable
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 landar nr nn attnrnpv hpfnrp crimmpnrina wnrk or rprnrdinLayour Notice of Commencement.
S' ature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF _ Lj_t_&e
before ' / Physical Presence Online Notarization
Sworn to (or affir d) and subscribed me of or
this ]�ay of 200? kk by
, —
Name of person making statement.
Personally Known V OR Produced Identification
Type of Identification oduced
(Sig to f ublic- tate of Florida)
Commission No�� 6` a(Seal)tomSmioe2D63EZ092
r Expires September 27, 2022
°'► F`°Y'flwM TNu Tray Fein 4&XM 800- W?019
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