HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `/ I
Date: Permit Number: G
RECEIVED
r� lloL-L�.1��15 iil;
R�
o r SEP 21 2021
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: SGauN WLWbuou CUFFLPcC,[ r�-LOT-
C *.-x}
PRQIa►siQ EMPtE11T QtCJIV �y4 ix s y
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Address: 1 & %LA K1. 0, �1,.� � i✓ j '��� C S—_L
Property Tax ID #: �I�l� ��(����Z Ir�(� �y Lot No. U*J1 17—
Site Plan Name: Block No. ('LAI —8.
Project Name: ALUMJLA-% SCOS LO.
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit —check all that apply:
(Affidavit required)
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors Pond
_ Electric _ Plumbing _Sprinklers _Generator _ Roof Pitch
Total Sq. Ft of Construction: LJ 00 S 0- Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: '—Sewer _ Septic Building Height:
'�'i�71r -..t h1 �'v2 "3't.+5
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Name_TL�,C_1rVKXLfl C_i—PAW-L
Name:
Address:16 Jq N.0, 5lJi L 1 (SN-A C- 'Z
Company:;Fi11_yO�s 5CUDi
UJr-'-tt�l�
City: FmLrA (_ 1 T`J State: ILL
Zip Code: _3Lt 0, Q C� Fax:
Phone No. E-
Address: 2�. Omit S_E_L6 ft JZN
zq�,
City: 1P_ S LL
Zip Code: Fax:
Phone No �%�Z— q)bS_ `i Gk
State:
Mail:
Fill in fee simple Title Holder on next page (if different
from
from the Owner listed above)
E-Mail Fl ► 3()S S C -LEEP ®
ATT,_ ("JET —
State or County License OKA
0a
If value of construction is 2500 or more; a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER:
Name: FI UI- \,JLkX,1A
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address: 1o$(-1 GJ L 1 r'-.0fU
S T *-%ILi
Address:
City: PznLt C-; _ L-Qc,(,i
Zip: Phone �791—
State: 'FL
I9119--g8b8_
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY: Not Applicable
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 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
with lender or an attornev before commencing work or recording your Notice of Commencement.
Sign r/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Swjr� to (or affir ) and subscribed before me of Physical Presence or Online Notarization
l by
thi: day o 2GJ_[
Lkl U P c QrJD Y 0 h) �r-A) e —T,
Name of person making statement.
/
Personally Known OR Produc entifica ion
Type of 10,eptification Produ
(Signature of Notary P ic- State of Florida)
AUDREY B. HUMPHREY
MY COMMISSION#GG300817
Commission No. (Seal) *_
`*= EXPIRES: March 6, 2023
'••F OF F�U Bonded Thru Notary Public underwriters
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Rev 5/20/21