HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
[
Date. Permit Number. C
��o.L' lwC F1ECElVED
° - Building. Permit-Application
NOV 10 2021
St.Ludia(County
Planning and Development Services Petrrilfti
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:
R OS02 1ENITA CJ T O
Address: 7[3�] l)S �. Qar� Stilnz 1- vC/e, ri✓ ���?SZ
Property Tax ID#: 'Lot No.
Site Plan Name: 94 6 DI/ On J//150 Block No.
Project Name: d*,0/!Y A2! /e rol
Mam 00MYMM O RIC•
New Electrical Meter. Second Electrical Meter (Affidavit required)
Ca
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:r� Sq. Ft.of First Floor:
Cost of Construction:$ J' 7Ci0 J 4 Utilities: —Sewer _Septic Building Height:
{ N R LE AC 1
Name Not /At4.q kZ4Iq Name: t' Z
Address: 7/31 SOr/A Company:.
City: Port s�: �ytcG Stater Address: (/74Yb SQ IhQ�4 G N.'
Zip Code: 3(.(`t fZ- Fax: City:M1' Yrt�� State:
Phone No. 772- ?/2 - 99VO E- Zip Code: 371 2-�� . Fax:
Mail: 17b4ai¢ 11 Va/1oo. w/tt Phone-No 772-- ZZY- SI/81
Fill in fee simple Title Holder on next page(if different E-Mail I
from the Owner listed above) State or County License 44t'crAf OcjP
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.
SUPPLEMENTALC4NSTRUCTt(JN LIEN LAW INF®RMATIQN
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: 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:
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 is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners 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 appro ed ptlans,the Florida Building Codes and St.Lucie County Amendments.
The following building pe it appf ications are exempt from undergoing a full concurrency r ew:room additions,
accessory structures,s -imming pools,fences,walls,signs,screen rooms and accessory es t another non-residential use
WARNING TO O NER:Xo r failure to Record a Notice of Commencemen ay r sult in paying twice for
improveme is to. o property. A Notice of Commencement mu r0corded in the public records of St.
Lucie Coun an o ted on the jobsite before the first inspection%to/L'
�9,6 intend to obtain financing, consult
with lend r or t efore commencin work or recordin t Notice of Commencement.
-7—��
Signature of O, her/Lessee/Contractor as Agent for Owner Signat re ontractor/License Holder
STATE OF FLO ID�q '� STATE OF FLORID�►�
COUNTY OF '! a<� -` COUNTY OF l 1(1
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
p�ltisical Presence or Online Notarization Pt..ysical Presence or Online Notarization
this, _day of [^ %f' � 2036 by this 2�day off f GT ,2026 by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Id ific tion Type of Ident' )ton
Produce Produced
s
(Signature of Notary P lic ignature of Notary Public- t4pgLbtflorida IVETTE LORENZO
IVETTE LORENZO saF; Gr Notary Public-State of Florida
:'z°• Lr= N �jublic-State of Florida ry
Commission NO. ~v �: Yhission r<GG 230691 Commission No. e0. sion#GG 230691
3 8 F rti° My of mm.'Expires Jun 20,2022
'S�oFEti°'' My Comm.Expires Jun 20,20I2
Notary Assn,
Bonded through National Notary Assn,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.