HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Z Permit Number:
RECEIVED
(C- SEP 23 2021
Building Permit Application ty
St.Lucie Courr
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 a CBDG Funding
5;
PERMIT APPLICATION FOR: W wd0S5
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID#: 02 -4/0—0.3/—& D-2- � ^ , Lot No.
Site Plan Name: Q Y4_ 70411 X419 —LkAZ Block No.
Project Name:� G 7)A&Ve" kk"6e
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DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter (Affidavit required)
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters JC Windows Doors _Pond
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ 4/ Me - '/�1 Utilities: —Sewer —Septic Building Height:
OWN ERAESSE•E: CO NTRACTOR:�
Name o4W1., Name: /MI q 'e 1 •
Address: &S-P -r dc¢#n , -tt-Ob/ Company: 1),1440^+ �v
City: 7giay? &uA State: GG Address: /6r e2
Zip Code: 5;V9S 7 Fax: City: /0 GtA7C-&e& State: A
Phone No. E- Zip Code: Fax:
Mail: Phone No 2.
Fill in fee simple Title Holder on next page(if different E-Mail %!I 9rd/an' gr=,A c77r
from the Owner listed above). State or County License o GI• /5i P
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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 CONSTRUCTION LIEN LAW INFORMATION.:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
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FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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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 inithe 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.
S:�� > -
Sign ture f Owner/Lessee/Co tractor as Agent for Owner
STATE OF FLORIPA
COUNTY OF
Sworn to(or affirmed)and subscribed before me of Physical Presence or Online No
this_2�__day of_ ��,k q\Q 20_2:�V by
Qhrm¢.rl YQ Coyamao
Name of person making statement.
Personally Known X OR Produced Identification
Type of Identifi ' n Produced
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(Signature oT-go-tioy Public-State of Florida) o'P% Notary Public state of Florida
a4 `t; Carmen N Goykhman
Commission No.CCa 2l tt 0AO (Seal) s My Commission GG 201740
y+,+ o1P Expires 0411312022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
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COMPLETED
Rev 5120121