HomeMy WebLinkAboutBuilding Permit Application All APPLICAB E INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �7
Date: Permit Number: I o-cc
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Building Permit Application SEP 2 2o2i
Planning and Development Services
Building and Code Regulation Division Commercial ResidentffP gw C
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR:
,.,PROPOSED.IM:P.ROVEMENT-1OCATI:ON,: -
Address:
Property Tax ID#: I!� 9-- a 2- ZZ-2/ 49 Lot No.`s A d l
Site Plan Name: KC77 Block No.
Project Name: �r
.DETAILED.DESCRIPTION OF WORK..
/4.-r Roo-r 6 ,y fu44
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 t�� Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ X N04- 4�fv Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE :CONTRACTOR:.
Name i I Name: 10YO VJ,, /v Y
Address:
: 2 ; 5 h�� Ie Company:
City. C State.EL Address: 2706 ATLANTIC AVE
Zip Code: Fax:, City: FORT PIERCE, FL4147
Phone No 'I �] E- Zip Code: Fax:
Mail: - Phone NoUZ�Z V5- �!
Fill in fee simple Title Holder on next page(if different E-Mail &AP&O 22191/2rg( 6t�Dor��.�'/'I/�
from the Owner listed above) State or County License=OMIT
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 CONSTRU,CTIONLIEN LAW.INFORMATIO.N
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phon
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.
r
SigZE
re of Owner/Lessee/Contractor as Agent for Owner
ST OF FLORIDA
COUNTY OF ��• L��,�e__
Sworn (or affirm )an subscribed before me of J_/_P
hysical Presence or Online Notarization
this day of i 201L by ,
Name of person making statement.
Personally Known��OR Produced Identification
Type of Identif' i Produced
(Signature of Notary Public-State of Florida) ` iqta S. minns
Commission No. -�x / 5 COWMIONI#GG256359 lC (Seal) _ s
EXPIRES: Sept 9, 2022
Bonded TM Aaltron Note
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev
CONDITIONAL RELEASE OF LIEN
STATE OF FLORIDA )
COUNTY OF
KNOW ALL MEN BY THESE PRESENTS:
The undersigned,for and in consideration of the sum of be received, but not yet received,
does hereby release his/her lien, and waive and relinquish the right to claim a lien in the amount of
$ ,20.E subject to the condition of payment described below,for labor, services,and materials
furnished for improvement of the following described property: e�� WA6 r PLO
D l�
1_aT5 � n1D1 C %�/���/
(legal description)
This is a Partial Release of Lien by the undersigned given pursuant to Fla.Stat. §713.20(3)for the sole
purpose of releasing the lien rights up to the amount above stated, and does not waive or release any
lien rights in excess of the stated sum. This Partial Waiver and Release of Lien is conditioned upon
payment of the consideration described above. It is not effective until said payment is received in_paid
funds.
have hereunto set m h d and se his[l day of 20a
IN WITNESS WHEREOF, I ha Y s��
7
BY:
The forgoing instrument was acknowledged before me this day of
4
by �.L (�ti�( /;(/ /1/�who is personally know to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC Sheniqua S. M ms
COWISSION 0 C4256368
COMMISSION NO: :.,� �,� EXPIRES: Sopt !,2022.
�fnu+ kr&d SIN Am NOWY
COMMISSION EXPIRES: