HomeMy WebLinkAboutjanice addison buildingpermit 10.30.2021 All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
� rr-
d Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
V/-
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: ..3XYY 6 / i
Property Tax ID#: ���� Z`' (e ( � Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
VIt Q n e-4 7, A, '
ec ! A p4 Z�
New Electrical Meter AP Second Electrical Meter V1,4 (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: 1,
Cost of Construction: $ 1Z,0&0, &0 Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name: _
Address: r Company:
City:_ serde e State: rL Address;ffi, to C' be
Zip Code: TWI Fax: 4114 City: Xr9'_h7_ 1<Glfr`� State: Alt
Phone No. `z U - *f 7J E- Zip Code: swa Fax: .41114
Mail: Phone N 2 Q
Fill in fee simple itle Holder on next page(if different E-Mail i ` , i!
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 CONSTRUCTIO LIEN LAW INFORMATION:
DESIGNER/ENGINEER: of Applicable MORTGAGE COMPANY: of 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 our Notice of Commencement.
Sign re f O ner/Lessee/Conta,ffiftor as Agent for Owner
c
STATE OF F '0Ri
COUNTY OF /�
Swor to(or affir a d subscribed before me of Ll Physical Prese cp or Online Notarization
this day of 2 by (�,5 � IA . �Y-447_,
Name of person making statement.
Personally Known OR Produced Identification
Type of Iden ' ' atio P o e
(Signat e of N tary Public-Stafte of Florida) - -=—'-""
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Commission No. (Seal) �I��Sy:AwnaLtC9.,zo�23 y
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5