HomeMy WebLinkAboutBuilding Permit Application Wills E'--S to U-CC0,10
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION'TO BE ACCEPTED
Date: Permit Number:al l f
RECEIVED
Q L� O G3 0 U n-
Building Permit Application St,Lucie County
Planning and Development Services Permitting
Building and Code Regulation Division Commercial Residential )�
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 7 �!�L SL cy'a'f e 4- ac+ j uc�e_ h L LA c1�/3
Property Tax ID#:���a, 7,01- 00 L4 - 0 0 0- 's Lot No.��
Site Plan Name: Block No.
Project Name: C7 ye( f,Ae, /Me,,f K 0 CZ 5
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Mete, (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: ?,SD Sq. Ft. of First Floor:
Cost of Construction: $ ,U DO Utilities: _Sewer _Septic Building Height: 9
OWNER/LESSEE: CONTRACTOR:
Name_C rrc7rl�v)e- wtrw'l ogu"�s Name: go
Address: �� �(_r��.tef Company: S'u vt r;5-Q ' ion C�K
City:-or� 1_uC.e State: Address:
Zip Code: Fax: City: 5t L :54 State: �L
Phone No. (� Lb(o 36/ E- Zip Code: 3 cPS Fax:
Mail: Phone No SD 'j
Fill in fee simple Title Holder on next page (if different E-Mail cAc��� hu5 Fov �c�L �tt�,�toP �co
from the Owner listed above) State or County License CCC /33 I MO
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.
r
PPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
SIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
me: Name:
dress: 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:
I
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 Cod ies 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 Cori�mencement 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 beforj commencing v�jork or recording our Notice of Commencement.
J't?.fK 9 4rS?'(ZtD UA w44e,
Sig ature of Owner/Lessee/Contra ent for Owner
STATE OF FLORIDA
COUNTY OF �T-,41 _
Sworn to(or affirmed)and subscribed before me of �Phy ical Presence or Online Notarization
this—i- day of �, / 20 611 by
bL CA n
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced
(Signature of Notary Public-State of Flori a)
Commission Nc(�-�]���lJ C(s�al) "aid', ELLEN VAUGHN
ate Sof Florida-Notary Public
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_� '= ommission # GG 270079
'�FOFFQ"AO My Commission Expires
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev /20/21