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HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �I �� (©��
Date:
Permit Number:
RECEIVED
S510 t �'CLE
46 l 2021
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, Building Permit Application
Stc ie n�
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St.
Planning and Development Services 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:
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Address: J 66$0 S. OCr-4✓-3 D2: ' t i f 0
Property Tax ID #: y,;) - 5)6 M'17 - 600 - 6 Lot No.
Site Plan Name: I jLAt-JD CAEST Lc�oi L)ox^ t tJ/V\ 1(1) Block No.
Project Name: GAM6u c, (P,9�5)VFJJCC
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New Electrical Meter Second Electrical Meter (Affidavit required)
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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 Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $=T�jq,�a Utilities: _ Sewer _ Septic Building} Height:
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Name ►)F�nJiPt22 GaM!bitL_ u,
Name; CA6 2ocGc,e5.
Company:- CO*sjr/- PCUM800r,
`Address: 97/ Sri a y_,EHu�esr- DP_. T
Address: _ l0GZ0 5. OCCAtJ Lam, ci1o, r
City: JF_N5 � i' AU 1 'State:''"fL
City: 'P.5.1-. State: CL
Zip Code: -34PSI Fax:
Phone No. W 1-7 -71 6 E-
Zip Code: 3 c 23 Fax:
Mail:(�R,v,b►�t,.JFN��P�2i�Con�cAsr.ti
Phone No 73,i940-114LI
Fill in fee simple Title Holder on next page (if different
E-Mail 3 0
State or County License Orv,4 1(408 a
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HA VC is $7,500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _
Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
_
Address:
Address:
City:
State:
City:
State:
Zip:
Phone
Zip: Phone:
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 vour Notice of`Commencement.
Signature of Own e essee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF a
Sworn to (or affirm d) and subscribed before me of X Physical Presence or Online Notarization
this 3_ day of IT 20 ZI by
C-mi c, Roc
Name of person making state
ent.
Personally Known OR
Produced Identification
Type of Identification Produced
491gnature of Notary Public- State of Florida)
Notary Public State of Florida
Commission No. (Seal) TRACY CARVALHO
�.:v1� My Commission GG 950192
OFpd� Expires 03/22/2024
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21