HomeMy WebLinkAbout301 NE Prima Vista BlvdAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: )'3 - :;)) Permit Number: �2
Planning and Development Services
RECEIVED
OCT 2 5 2021
Building Permit Application St, LUcivCo"ntY
permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Commercial X Residential
Address: 30 ) P r o� \(�- i51iJA
Property Tax ID #: s3q Iq f �;-36 " 60'Z I9-L)W" I Lot No. 33j j y 35
Site Plan Name: Block No. _:52
Project Name:
New Electrical Meter
Second Electrical Meter
Additional work to be performed under this permit - check all that apply:
_Mechanical
Electric
_ Gas Tank
Plumbing
Total Sq. Ft of Construction:
Gas Piping _ Shutters
�ie LnXc `i `ne-
(Affidavit required)
Windows/Doors — Pond
Sprinklers _ Generator _ Roof Pitch
Sq. Ft. of First Floor:
Cost of Construction: $ �. r�. :1 1S . 5 ti Utilities: )( Sewer _Septic Building Height:
Name ir�CiaiL+iC Ll--�:
Address: JA ?,4i5e e,C12,LK SL
City: s*11q 'Pi�clr& . Stater
id
Zip Code: ggLI(CQ Fax:
Phone No. -I-7a - 5'+S- q )
E-Mail: -sec%, ecczx-2tc7vk&,
Fill in fee simple Title Holder on next page { if different
from the Owner listed above)
Name:��asM��).FCc�CZ
Company:
Address: /?1q)� SE 16(r`:,\e
City: ?KA S+ \- \f State:
Zip Code: 51- 6 A Fax:
Phone No 77,)- /n14 �- 070'K
E-MailCi1 (�y lna�r'fdn CO/�'j
State or County License (FC1 LodB—n 4
If value of construction is 2500 or more, a RECORDED Notice of Commencement is requirea.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
MORTGAGE COMPANY: _ Not Applicable
DESIGNER/ENGINEER: — 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 is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners 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 len er an attorney before commencing work or recording our Notice of Commencement.
IV
JA
Signature 0 Lessee/Contractor as Agent for Owner
STATE O ORID
COUNTY OF �.uG:-�
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this ',;6 day of ( 20,)A by
Name of person making statement.
Personally Known `//lOR Produced Identification
Type of Identification Produced
(Signature o Notary Public- State of FI -
.yr+ pert' Notary P�te of FlantlaCommission No. (e ; Cheryl FMy CommissionH 1 i6177
"SgJi`ti0 Expires04/11/2025
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Rev Z 21