HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE IN O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: D Permit Number:
9M LUCE RECEIVED
!� 'I L�::. y:: ~ OCT 2 7 2021
` ''`` Building Permit Application
St.I_ucle CAuncy
Planning and Development Services Peffniffifla
Building and Code Regulation Division Commercial Residential i
2300 Virginia Avenue, Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATIQ'N:
Address: I'e SSVv
Property Tax ID#: (Do — c3 L7 J - Lot No.�
Site Plan Name: Block No.
Project Name:
`DETAILED DESCRIPTION OF WORK: Q'WLJ�
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 Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 200 00 Utilities: —Sewer —Septic Building Height:
OWNER/LESS`EE . CONTRACTOR: =
Name _ - Name: -
Address: LM 1 Company:
City: ;RlC State Address:
Zip Code: ti 2 Fax: Al 16- City: State:
Phone No. 112 - 2�6 CS S� E- Zip Code: Fax:
Mail: jA C I-As k � Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
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 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 consu t 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� AG CATHERINE JIMENEZ
ignat er/Lessee/Contractor as Agent for Owner =� �� Notary Public,State of Florida
Commissicn#GO 921213
ST OF FLORIDA hey comet.expire;October 8,2023
COUNTY OF F}' �e-1,e-
:.'.. -
Sworip to(or affirmedliind subscribed before me of Physical Presence or Online Notarization
this__Y day of P_o' 2021 by
Name of person making statement. HEATHER B U R F 0,
1 A P j"'
� `ozState of Florida-Notary F
Personally nown P
Produced Identification ®Q Commission # GO 1s
Ty p f Id ication r %10�s ��poi My Commission Exp:
February 06, 2022'
e
(Signatur of Notary ub - tate o orida) /0 Z/
C ) 7Notary
RINE JIMENE2 �[
Commission No. `7 d l✓1 Seal opQ� p°m� lic State of Florlda
ion#GG 921213
pires October 8,2023
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev