HomeMy WebLinkAboutPermit Application - Nov 15 2021 - 12-49 PMAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number: Z / 0 1 - Ob0 S
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Building Permit Application
Planning and Development Services
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: Cl YO 3
5 AUV. E-r4 T I-.4C2 . T?L. 339L(
Property Tax ID #: i' L13 ( - 1 t71 - 00 9 S - 60 0 Z/ Lot No. _
Site Plan Name: Block No.
Project Name: Ak Q 5 1 0 2 y S i A 4-, ce
DETAILED DESCRIPTION OF WORK:
,C/zLd Co"k 51,Vuc +l vvt 5 KS Ca -a- t Cy
New Electrical Meter
Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
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: / 500 Sq. Ft. of First Floor: / 500
Cost of Construction: $ Utilities: —Sewer Eeptic) Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name_ 5 I D-Z y
Address: A VA
City: t ��Q State: _-
Zip Code: �3 i/y Fax:
Name: A -k
Company: tO %J I$ u i sL/ 5 Ll C' ,
Address: U 4 t,
City: A_ -f t State: _E t
Phone No. E-
Mail: AAuX G- 5.4( //1 _ t o L4rA �• Cowl
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Zip Code: Fax:
Phone No 305 2
E-Mail J < < .9 4
State or County License
If value of construction is Z50o or more, a RECORDED Notice of Commencement is requirea.
If value of HAVC Is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIG ER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
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 grantin 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
..,,+k 1enAa r nr nn n++nrne., hoftro rr%mmanrino wnrk nr rprnrdine your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA .4
COUNTY OF c t
Sworn to (or affirmed) and subscribed before me of x Physical Presence or Online Notarization
this _L�ilay of �D✓ Ion . 20A by
Q atk 2 A u_�
Name of person fnaking statement.
Personally Known _)e' OR Produced Identification
Type of Identification/Produced
4 ec &,-
(Signature of Notary Public- State of Florida)
No. t9J Z3 Z (Seal)
Commission ��,. CH LIZANOELIAAMQRROJARA
Notary
a PubArti State of Fbrida
* Commission No. HH 46023
Commission Expires M312024
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev /20/21