HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO'MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: m
'-• _ RECEIVED
NOV 01 2021
Building.Permit Application
Permitting Department
Planning Ond DevelopmentSelviCeS t. Lucie County
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34982 _
Phone:(772)462-1553 Fax:(712)462-1578
PERMIT APPLICATION FOR: lGy(
PROPOSED-IMPROVEMENT LOCATION:
Address: r�76 7 ' l/�
PropertyTax lD-#:15�0��-'zO/-D A 7-J!60- t� _ Lot No.
Site Plan Name: &2/l&1 �i1� 1 Block No'
Project Name:g40,z ,, 0. z4&,o-1
DETA)LED.-DESCRIPTION-,OF WORk:
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New Electrical Meter Second Electrical Meter
CONSTRUCTION 1NFORMATI.ON:
Additional work to be performed under this permit-check all that apply:
i _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: Utilities: _Sewer _Septic Building Height:
OWN5R LESSEE: CONTRACTOR:
- a
Name Name:
Address: Company:
a
City: .���r�� -State:C7 Address: 8 a
Zip Code:,fir 'g Fax: City: ';
State'AG
Phone No. /. '��- 8lr'7 Zip Code:� 9�"3 _ Fax:
E-Mail:dl42'a4" /D @ Qve • COA Phone Nol M .3�i�aPl'e2X�7
Fill in fee simple Title'Holder on next page{if different E-Mail ® 0,Le,► COr't
from the Owner listed above) State or County License
If value of-construction is 2500 or more,a-RECORDED 1lotfce of Commencement is required.
i If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
i,
SUPPLEMENTAL CONSTRUC N LIEN LAIN INFORMATION:
DESIGNS R/ENGINEER. Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State_ City: State:
Zip: Phone Zip: Phone:
4 FEE SIMPLE TITLE HOLDER; Not Applicable $ONDiNG 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 wilt authorize theEranyrnons
rmit holder to 6ui(d the subject structure
which is in tort Ict with any appCcable.Home Owners Association rules,bylaws ranovenants that may restrict or prohibit such
structure.Please consult wEth your Home Owners Assodatian and reviewgour deed estcti which may apply.
In consideration of the granting of this requested permit,I do hereby agree that 1 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,wails,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 u intend to obtain financing,consult
with lender or an attorney,before commencinx work or ordinp,vou Lice of Commencement.
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Signature vuner Lm Agpner Signature
STATE OF FLORIDASTATE OF FLOR�ID�
COUNTY Ol:_ 1 a�+A D COUNTY OF 1�� u n.c 0
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S to(or affirmed)and subscribed before me of S�Io��rn to(or affirmed)and subscribed before me of
woMh SICdI Presence r Online Notarization rl— Physical Pres nce or Online Notarization
this, day of thi r'
204 by s day of 20jL by
Name of Oersbn WaYing statement. Name of p rson ma i statement.
li Personally KnownOR Produced Identification Personally Known �OR Produced identification
Type of Identification 'type of Identification
Produced Produced
Zj A V_
(signature of Notary Public-State //������na re of Nata Public State of Florida)
Notary Public State df Idr� ry � ���
aQ `E Bunrne Merritt Wood'a d r�
Commission No. t� t Notary Public State 1
eal) My Commission HH 0 9C&nm ion No.
Expires 09/07/2024 ? Bunnie Merntt W
fior n My CommIsSion H 0 826
~ Ez tres 09/0712024
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
j COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
1 DATE
RECEIVED
DATE
COMPLETED
L'1f: 20
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