HomeMy WebLinkAboutBuilding Permit Application 9-22-21 All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �f
Date:
7/ A®, I Permit Number: /��'
RECEIVED
Building Permit Application
!3E ►�ucl panty
Planning and Development Services Q Ittillg
(Building and Code Regulation Division Commercial Residential
12300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR:
'!PROPOSED IMPROVEMENT LOCATION:
Address: !7®1 7ap,4 i'A l h d L-4jh All✓ior
P roperty Tax ID#: 3IF.�, 1-7 Jola I �®OoZ, —0670 Lot No.
�
Site Plan Name: 01/? dl(,I1 Pil te-P/' OP I fy-e Block No.
PlrolectName: 7($I0(/lRh /�y-ef 01YV-e o
DETAILED DESCRIPTION OF WORK:
I0%hsjg1/ nvyA an fah vj ' A&--,cs-e . aorch '+y 4�,1-v P
'n y hAl�yd om ol,er �i
40 teh dmorf,
ew Electrical Meter Second Electrical Meter (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:
Cost of Construction: $ 1 610®/ C Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE CONTRACTOR:
Name 7-0014, 1 n Name: 4
Pf n.,1 No,
Address: ®/ i W 11Obv-Pf (✓-et Company:_7j4r ;/�0/Y°
City:41 LH tYle Clyt4 ri/'Y, State:&f Address: 13/71✓j 0tr�li S/Y
Zip Code: N1700 Fax: / City: Pi 51 Lt State:-8�e
Phone No. �6 / — 7.21 — !ff/ E- Zip Code: 3 V 9 3 Fax:
(Mail: dihwif JL7(@ m o Phone No 77A^ t'a/" 6a0 Y
Fill in fee simple Title Holder on next page (if different E-Mail dA&f/e 22 A/ /`;&y1
'from the Owner listed above) State or County,License �73®
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.
I
St1PpLEMENTA1 CONSTRUCTI01V LIEN LAUI/1NFORMATION k 4
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: r _Not Applicable
Name: 56-f-en t09j' 0- Name: _
Address: YYo1 Wa-e and get, fr.,Y e 44 Address:
L State:
City: Or-la..do State: City:
Zip: Phone IY07— 73Y—IY70 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,
alccessory 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.
Sig ature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to(or affirmed)and subscribed before me of "�Pphysical Presence or Online Notarization
this g day of .`�eitOl" zoo by ���c n ni 5 Al
I Q _
1 Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced T=G. rt viq L c
(Signature of Notary Public-State of Florida)
o� 3 Y 4': BARBARA MILILLO
Commission No. �4/ (Seal) �; =a • �.
Notary Public-State of Florida
k `-•.'�aF�ot' Commission#GG 237991
My Comm.Expires Jul 12,2022
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DATE
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DATE
COMPLETED
Rev 5/20/21