HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED e {� 7 6
Date: a0 Permit Number:
S ti�LL:C -L RECEIVED
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Buiading Permit Application OCT 2 5 2021
Planning and Development Services St.Lucie county
Permitting
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: g0 S OC,ee'r\.Dr kph n 410
PropertyTaxlD#: 3�3J "'�0�'":d0.7(0 — f?00- 3 tot No.
Site Plan Name: -�--S�-QLM '�DtA`Y\P3 COS Block No.
Pro'ect Name:DETAILED:DESCRIPTION°OF WORK:
l a l �_ St1 tl,eIpWfu
New Electrical Meter Second Electrical Meter (Affidavit required)
-CONSTRUCTION INFORMATION: _
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Additional work to be performed under this permit—check all that apply:
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_Mechanical _Gas Tank _Gas Piping' _Shutters _Windows/Doors `Pond
_�Z'Electric —Plumbing _Sprinklers _Generator _Roof Pitch
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Total'Sq. Ft of Construction: /,0/ Sq. Ft.of First Floor: 1.6 f
Cost of Construction:$ -HOO.017 Utilities: _Sewer _Septic Building Height:
OWN ER/LESSEE:.'` CONTRACTOR:
Name Xame_ � 3 D2i0oCa\-, 0- Sa�,y.6\d\9-V Name: mcxii �Zw .` VQ:S
Address: C?9,90 S- QCP,00.3r\ UV '\k 'oal` Company: VeS «C.riC. L
City: S@t\StY\• State: t•- Address: 2.'90 S k L.5,A—ra o6r\ A -Q
Zip Code: Fax: City: l�e O' .PCi\M State:
Phone No. E- Zip Code: S 3'(0-7 Fax:
Mails Phone No-5i�
Fill in fee simple Title Holder on next page(if different &Mail
from the Owner listed above) State or County License ;C--G 1300 Q0.2 q
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:INFORMATfON
DESIGNER/ENGINEER: `Not ApplicableI MORTGAGE COMPANY. _Not Applicable
Name: Name:
Address: I Address:
City: State: I City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: `Not Applicable � BONDING COMPANY: Not Applicable
Name: Name:-
Address: Address:
City: ! City:
Zip: Phone: I Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is herel;y 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 a ' 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 attorneybefore commendn work or recording our Notice of Commencement.
Signature of Owner/Less a/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF .'PG.I c,6
Sworn to(or affirmed)and subscribed before me of Physical Presence or Online Notarization
tFiis � 20�by
Name of person making statement. I
Personally Known OR Produced Identification k
Type of ldjgi4ification Produced f=/_ Dl>- -= I?-0—"s-qC5—r r, —3c g—C,
(Signature of Notary Public-State of Florida) J
Commission No. (Seal ROBERTSOLOMON
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�. t MY COMMISSION#GG 919917
EXPIRES:October 6,2023
~AFOFF°` Bonded Thru Notary Public Underwriters
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DATE
RECEIVED
DATE
COMPLETED
ev5/20/21