HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a Permit Number:
o LOOM SEP 0 2 2021
0 St. Lucie County
Building Permit Application Permitting
Planning and Development Services
Building and Code Regulation Division Commercial Residential x"'
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: &1eCava
ouwrpel
U.
Address: /a) Cowayi 4)(, 2,(-4 .,L. _'SeAcISI
Property Tax lD#: Lot No.
Site Plan Name: _zossoyta Block No.
Project Name:
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New Electrical Meter Second Electrical Meter (Affidavit required)
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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: Sq. Ft. of First Floor:
Cost of"Construction: $ Utilities: —Sewer —Septic Building Height:
Name 'J )sSoy'e-
Name, RuIoRA T ACCL^%o
Address: j53G5 �e,&oy� i)r-
Company: Arrtwy
City: PO4 S1. /'UC1__1' State: F?.
Address: OM 91 re_ A4(w_4
Zip Code: 3L4 9 9:1 Fax:
City: 9(-_ Stater1.
Phone No.
Zip Code: Fax: =14 2"
E-Mail:
Phone No
Fill in fee simple Title Holder on next page if different
E-Mail Aacvq; 15
from the Owner listed above)
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State or County License_C&C- 05 85Cr-*
If value of construction is 2500 or more, a RECORDED Notice or Commencement is requirea.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: /Not Applicable
Name:, @Ue✓t r,. t Jco
Name:
Addr s: g50 SW C,) J n
Address:
City: Y04 59.
State:
City:
State:
Zip: 3"qGL Phone a
Zip:
Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: yNot 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 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 attorney.before commencing work or recording your Notice of Commencement.
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Sign ure Own as Agent for Owner
STATE OF FLORIDA
COUNTY OF S-1 . /_U6)2�
Sworn toJor affirm d) and subscribed before me of ✓ Physical Presence or Online Notarization
this —day of AoAtA420Z by
21)be", r er a
,"
Name of person makibg statement.
Personally Known ✓ OR Produced Identification
Type of Identification Produced
ILJJ A.L
(Signature of Nota
Notary Public State of Florida
Commission No. +y Michael06"erson
+� My Commission.GG 309707
M w Expires 0311012023
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
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DATE
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DATE
COMPLETED
Rev 5/20121