HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I Permit Number:
LLF �JlloL`C-flR
6ol a
RKENE0
NOV 01 10
Planning and Development Services
Building Permit Application Pe%�tting Depa rr►ent
r i
r .
Building and Code Regulation Division Commercial Residential tTU'tfacie Coot`!
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 `.,
PERMIT APPLICATION FOR:
Address: c�Sa3 (a KDlIE` (i�L�
Property Tax ID #: 1410 310 0005 000 le Lot No.
Site Plan Name:
Project Name:
Block No.
&
"aIp S}in4 a00 prw0 MGi'dr h tul DD 4wlC 1'1�,j
r
Co M Lo E✓N e/6""
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit - check all that apply:
(Affidavit required)
_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: $ l0l,L Utilities: — Sewer _ Septic Building Height:
FAc47<dVA'
Address: 8a � V % Pnz
City: r-,P- P/ 4 ` C State:
Zip Code: 9 8 1 Fax: N14
Phone No. 772 - Z/ 6 31S 2y
E-Mail: /U %A
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: aa-SoA, Rr.,.lrrba%
Company: S-)- L",e, k-lec,fri
Address: �Otr De -lac✓ 4, C 14✓G
City: F07 ,+ P.�re'e" State: FL_
Zip Code: 34141 Fax:
Phone No 7 7 �k- aI (9 )L0 Ll 1
E-Mail 7"orl 1p 5 L t cA S►4 , iG i' _
State or County License Lye_ 13 60 9 i 3
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:
Zi p: 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 lender or Cattqoey before commencing work or recording r Notice of Commencement.
Signature of ner/ Lessee/Contractor as Agent for Owner
Signatur f ontractor cense Holder
STATE OF FLORIDA� �uC I�
COUNTY OF
Wt
COUNTY OFORIDA� I , ,CIe
Sv�oy�i to (or affirmed) and subscribed before me of
Swo to (or affirmed) and subscribed before me of
�� Physical Presence or Online Notarization
this 14vr- day of NO 1J0499to 12020 by
Physical Presence or Online Notarization
this I 3r day of Ale Uv,ct - 12020 by
So S uo v� I ersD,�
SQ S��n IZ>� u 1 e1►� b�
Name of person making statement.
Name of person making statement.
Personally Known " OR Produced Identification
Personally Known 'ngOR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Sig ure of Notary Public-
(n�
Commission No. vl
iaa
on a MEUS8AMARTIN
MY COMMISSION # GG 94f45c
oP, (�€P ES: February
►► Bonded Thru Notary Public Underwri�<
ature of Notary Public- a$' ri 1
f ;•: ,;� COMMISSION # GG W45
a: I S: February 27, 2024
Qpmmission No. q F.., AM Notary
� Public Undenvril
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