HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: �� ' U -7su"T
(? 171 rl('a RECEIVED
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OCT 2 7 2021
Building Permit Application 81.Lucie County
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: �r i��Can C r✓
PROPOSED IlVIPROVEME,NT LOCATION
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Address: 910H /Ayna� �; C%�g-ck
Property Tax ID 4:_ I - �C��-- �( ( j Lot No. 3 7-
Site Plan Name: Block No. L�
Project Name:
DETA'ILED`DESCRIPTION;OF 111/ORK
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New Electrical Meter Second Electrical Meter (Affidavit required)
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CO�'NSTRUCT(OIV I N b 11"MATI O N � '
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:
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Cost of Construction: $ Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE COIVTRA'CTOR
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Name_ Tohn M. ��rtin�S � Name.
Address: g IO L-1 Arja 1 , C�r- Company:
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City: ��,, �;�rce State: M Address:
Zip Code: 3LA A5 I Fax: City: State:
Phone No. L]1 2_ LI Q�1_ 13 2_9 E- Zip Code: , Fax:
Mail: TE)L!!YL?_Q1.VE 0 6tIA -L COM 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,LAWINFORMATibN...
/ .,.,. MORTGAGE
DESIGNER ENGINEER: �/ Not Applicable COMPANY. ;/ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: V 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 our Notice of Commencement.
/r
Signal,Crre of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to(or affirmed)and subscribed before me of �fihysical Presence or Online Notarization
this 2-7 day of_ 210,Z by
Name of person making statement.
Personally Known OR Produced Identification
Type of I entification Produced y
(Signature of Notary Public) to of Florida)
HEATHER BURFORD
Commission No. (Seal) ,'_� e�- state of Florida_Notary Public
3+ •_ commission # GG 183217
;; ,'`: My Commission Expires
� February 06, 2022
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DATE
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DATE
COMPLETED
I—ev-5/20121