HomeMy WebLinkAboutBuilding Permit Application r
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ,e-�
Date: ! �2'�) Permit Number:V AAI V _ y7&—D
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L ,�'c-LL �_ I RECEIVED
OCT 25 2021
Building Permit Application
Planningand Development St.Lucie County
P i 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: Qogb 5 0r 2 in �C Ur\1 L!Q
Property Tax ID#: 5-1 Lot No.
Site Plan Name: Z Sko'A& �('Q S 910 Block No.
Project Name: Pazk rF �251C�P61G1✓✓
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DETAILED DESCRIPTION OF WO.RK:,
4v)�G-c isn a �DOA y 0 a' ax,h,u " I'd Iyt'�w
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this perm it—check all that apply:
_Mechanical _Gas Tank ^Gas Piping _Shutters _Windows/Doors _Pond
_,/'Electric —Plumbing —Sprinklers —Generator —Roof Pitch
Total Sq. Ft of Construction: j`( 6 �. Sq. Ft. of First Floor: l ) f 9
Cost of Construction:$ 300. 0 Q Utilities: . —Sewer —Septic Building Height:
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OWNER/LESSEE: CONTRACTOR:
Name �P,.n1Qy�'et' CsaMbi �\ oLkR-t Name: MnA-k�\ W I VIES
Address:_10 D W 5. UG?XV(, V r. L>n 1-t �W Company: TJ E S
City: '7-�P.n e.,A S P rxG`n State: Fl., Address: a dS PM Sirl 104) J
Zip Code: 214457 Fax: I City: \'Je5-k Pa\M RezO-, State:L
Phone No. E- Zip Code: '3 34 0` ' Fax:
Mail: Phone No 3!3,' a25 H
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
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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 1 MORTGAGE COMPANY: _Not Applicable
Name: i Name:
Address: I Address:
City: State: I City.: State:
.Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: Not Applicable 9OND1NG COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: i Zip: Phone:
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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 attorneybefore commencin %work or recording our Notice of Commencement.
Signature of Owner/Lessee/Co tractor as Agent for Owner
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STATE OF FLORIDA
COUNTY OF j?)., T3
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Sworn to(or affirmed)and subscribed before me of k Physical Presence or Online Notarization
this ate_day of Oc�rv�e,- 2021 by
Name of person making statement.
Personally Known OR Produced Identification �c
Type of Iden ication ProducedfL.DL = I10 5 So—'c:< •36(;—C>
—Z3-21
(Signature of Notary Public-State of Florida
=ot Yet c, ROSERTSOLOMON
Commission No. (Seal) i* *. MY COMMISSION#GG 919917
EXPIRES:October 6,2023
Bonded Thru Notary Public Underwriters ,
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