HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMP,,__ _:D FOR APPLICATION TO BE ACCEPTED 4"
Date
Permit Number: 0210Y-11647r
9�o Ls0�. RecE,vED
Building Permit Application AUG 0 5 2021
Planning and Development Services St. Lucie County
Building and Code Regulation Division Commercial 6 -S' Residential Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
Property Tax ID #: _
Site Plan Name: i
Project Name:
2r S''7" L &' .c, I
//- A 1; *5` 'A e,/Loss /M
Lot No._
Block No.
t,✓A TO LoW5 x • y®''iNc'1-1k'X fie"" 6�4'0
N(,oCn. .41
New Electrical Meter Second Electrical Meter (Affidavit required)
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Porno&
""V Electric _ Plumbing Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:' 0 , r Sq. Ft. of First Floor: 'a
fl
Cost of Construction: $ 4000 Utilities: _ Sewer _ Septic Building Height:
Name
Address:o yLdt-t✓may
City: POA-KS'%a 6V'G1, ✓ State: L.
Zip Code: Fax:
Phone No. 11, cr/'�Z — I;*
E-Mai1: 0-,4V✓> g,o,,,a754Kr- 00 8,97-/LtasL•L0,
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: /Au t/j b �V (r�' Zee °.
Company: Fri s`Zg— COi�S�2u.cllo7u l t'C
Address: `� 7 L j S.W.,
City: 10O/Lr Sly tvudState:
Zip Code: 0 Fax: N A
Phone No 77i 61-/ 0 6
E-Mail W W , (1-1- bg C,0t �'KL`C )P. . COM
State or County License o s C M 6 "T l 6 1
If value of construction is 2500 or more, a RECORDED Notice of commencement is requireu.
If value of HAVC is $7,500'or more, a RECORDED Notice of Commencement is required. •
(y } p u
DESIGNER/ENGINEER: _Not Applicable
City: s7 = Ll,,c; State:
Zip: Phone �S6 1- 6a 5— I; q�
_ I
MORTGAGE COMPANY
City:
Zip: Phone:!
Not Applicable'
I
State:
�
FEE SIMPLE`TITLE,'HOLDER:
Name:
Address:
City:
Zip: Phone:
Not Applicable
BONDING COMPANY:
Name:.
Address:
City:
Zip: Phone:
Not Applicable
!
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do t6 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 grunting 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 covenant's 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 approved plans, the Florida Building Codes and St. Lucie County Amend'' ents.
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�lt
nother non -residential -"use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may res in paying twice for
improvements to your property. A Notice of Commencement must be reco%ded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you int,nd to obtain financing, consult
with lender or an attorney before commencing work or recording your Notice of Commencement.
A7-
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Signature of Ow er/ e e ctor as Agent for Owner
STATE OF FLORIDA
COUNTY OF <
Sworn to (or affirm d) anq subscribed before me of YPhysical Presence or O
this --5� day of 2011 by
Name of person makingstatement.
Personally Know r��_ OR Produced Identification
Type of Identifica , nit�Produced / /1
(Signature of"Nelt�jrL�i Public- S(tyate of Florida )
Commission No. t"I r I �� "I �I�� (Seal)
REVIEWS I FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
=orsY wig Notary Public State of Florida
Samantha M Polito
y _ • My Commission HH 004714
�oin4� Expires;05128/2024
.ry
SUPERVISOR PLANS V.WETATION
REVIEW REVIEW" ``'jtEVIEW
nline Notarization
SEA TURTLE MANGROVE
REVIEW REVIEW