HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMF)L_.;:D FOR APPLICATION TO BE ACCEPTED ,3
Date: m\36a1 Permit Number:
RECEIVED
o SEP 3 0 2021
p ° Building Permit Application �t �Na,�G�dnty
Planning and Development Services pwNfI4
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: J
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Address: ? _In1 F+ I 1 .-2 i" Q
Property Tax ID#: rsis, q?-a oop I a 6 (� • 4 Lot No.
Site Plan Name: A IA4p Zon e, —4 3G 0 4 Block No.
Project Name: A I0 cne. J± -36o
DETAILED DESCRIPTION OF WORK:
1
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
n
Additional work to be performed under this permit— check all that apply:
Mechanical Gas Tank _ Gas Piping Shutters Windows/Doors
/Fi'r� — —
— Pond
— Electric — Plumbing —Sprinklers — Generator — Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ o�(' 00 0. 0 o Utilities: —Sewer —Septic Building Height:
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name f I
n tA 1 Q AQ i_LC
Name: (1 u
Company:
Address: (�. 0 ,
City: MXA, Stat
Address: -I 3 S VJ •
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Zip Code: JtPFax:
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City: 4u' or+.
State97-10-1
Phone No. E-
Zip Code: 3�-1 q9
Phone No qqQ.(A3.D3Qo
Fax:
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Mail:
Fill in fee simple Title Holder on next page (if different
E-Mail Ac V— �--
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State or Co my License F
ee 13.
(9 00.4
from the Owner listed above)
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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
Name: _
Address:
City:
Zip:
Phone
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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.
Signatf of Owner/ Lessee/Contractor as Agent for Owner
STATE OF ILLINOIS
COUNTY OF Dupage
Sworn to (or affirmed) and subscribed befoor�e me of X Physical Presence or Online Notarization
this 29thday of Sept. , 202
0 21 by
Name of person making statement.
Personally Known X OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- State of Illinois)
Commission No. (Seal)
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