HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: o & Permit Number:
NJ o UZUK « RecerveD
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p� � s F, NOV 15 1021
`� Building Permit Application
Permitting Department
Planning and Development Services St, Lucie Coun
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1S78 CBDG Funding
PERMIT APPLICATION FOR:IlyJ
PROPOSED IMPROVEMENT LOCATION:``
Address: 21/11������
Property Tax ID #: h" �(��^ cc��'�(� ` Lot No.
Site Plan Name: l�i� Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
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: $ Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name' it L P%
Name: R'�AAy k �.i
Company: - , V t
Address: ,
Address: � wV-
City: Stater
Zip Code: Fax:
City FL( State` 07
Phone No. '- E-
Zip Code: �� Fax:
Phone No r
Mail:
Fill in fee simple Title Holder on next page (if different
E-Maib ► G�
from the Owner listed above)
State or County Licens O Ile,
It value or construction is ewu or more, a KtGUKutu Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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MICHELLE R. MILLER, CLERK OF THE CIRCUIT COURT - SAINT LUCIE COUNTY
FILE # 4951692 OR BOOK 4720 PAGE 717, Recorded 11/15/2021 10:59:25 AM
Permit No.
State of Florida County of St. Lucie
NOTICE OF COMMENCEMENT
Tax Foiio No_%��! 6O /f V Coo ~
The undersigned hereby gives notice that improvement will be made to certain real property, and In accordance with Chapter 713, Florida Statutes,
the following information Is provided In this Notice of Commencement.
g 1 Descri ti n of Pro er : a d stre a re if avallabl //7/O
General description of hnprovernent:12 o l`r iti kh[,.
Owner information+ or Lessee in
Name U/iu1 /" q.
Address
{nterest1 prope y:
Name and address of fee simple
the Lessee contracted for the improvement:
different from Owner
Contractors Name: kv
'L ~
Contractor Address: Phone Number.
Surety (if app)icable, a copy of the payment bond Is attached): Amount of bond: $
Name and address: Phone number:
Lender Nam a: _
Lenders address:
Number:
Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided bySection
713.13(1) ( )7. F orida ttF s: _ l
Name: Ab �a ��� - - one M t,2�7 SAL%
Address:/'
In addition to himself or herself, Owner designates of
Uenors Notice as provided in Section 713.13(1) (b), Florida Statutes.
Phone number of person or entity designated by owner:
to receive a copy of the
Expiration date of notice of commencement: (the expiration date may not be before the completion of construction and final payment to the
contractor, but will be 1 year from the date of recording unless a different date is specified)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTERTHE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED
IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA STATUTES, AfpD CAN RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORETHE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR
RECORDING YOUR NOTICE OF COMMENCEMENT.
foregoing notice of commencement and that the facts stated therein are true to the best of
a v,? 2 (_-)L jyAe V-
(Signatorl/s Title/Office)
STATE OF F RIDA
COUNTY O
The foregoing,1 strument w sack owl deed before me by means o physical presence or 0 online notarization this V) day of
•.Twho is personally known to me or has produced)t6i �l .y,u- as Identification.
i te_ • i hctacy =co8c - State of Florida
[NOTARIAL SEAL] ,��'��`:.pCommission 4 HH 144027
My Comm. Ezpires Aug 15, 2025 OTARY PUBLIC, State of FlofFda
IHEREBY CERTIFY THAT THIS WCUMENT IS A TRUE AND CORRECT COPY OF AN OFFICIAL RECORD OR Digitall�f,/ signed by The Honorable Michelle R. Miller
DOCUSIENT AUTHORIZED B1' LAW TO BF. RECORDED OR FILED AND ACTUALLY RECORDED OR FILED IN' Date: 2 O L 1 . 11 . 1 5 11 : 0 1 : S 0 - Q S : Q Q
TIIF. OFFICE OFTHE ST. LUCIE COUNTY CLERK OF THE CIRCUIT COL'Rl'. Reason: Electronically Certified Copy
THIS DOCUMENT MAY HAY'F. REDACTIONS AS REQUIRED BYLAW.
T.nrafinnr 201 .Srnith Tnrlian Rivar fir. FnrY Piarna. FT. '1495(1
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 your Notice of Commencement.
Sign a ci wn Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF iA: ,:e
Sworn top affirmed ajid subscribed before me of 1---�ysical Presence or Online Notarization
this day of WLI 20_ by
Name of person making statement.
Personally Known OR ProdLI%.Qd� Identification
Type of Identification Produced _ 6�
(Signature ofr4otary Public! tate of F orida)
Commission No. (Seal)
THER BURFORD
rF--'4'7Februarv
f Florida -Notary Public
ission #GG 183217
ommission Expires
uar
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Rev 5/20/21