HomeMy WebLinkAboutBUILDING PERMIT APPLICATION ,
All APPLICABLE INFO-MUST BE COMP'L 16b F i NICATION TO Be ACCEPTED 1 f � 4
Date: ��" b�C 2021 Permit Number: l I
St.Lucie County
a Permitting
•
Building.Permit,Application
Planning onc!'DevelopmentServlces
Building and code Regulation Division COmmerciat Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772}462-1553 Fax:(712)462-1578
PERMIT APPLICATION FOR:
PROPOSED' IMPROVEMENT LOCATION: 1
Address:,- � � L. �• �.[p r� ��� ��.�
Lot No
Site Plan Name: ,t. .e} f� �� Block No.
Project Name: l�Y nl
DETAILLED-DIHSCRIPTION tOF WORK:
Oly. a r ,
New Electrical Meter A2# Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit—check all that apply:
Mechanical _Gas Tank —Gas Piping Shutters _Wlndotnrs/.Doors ____Pond
_Electric —Plumbing Sprinklers _Generator Roof Pitch.
Total-Sq.Ft of Construction: �o� 5q-Ft.of First'Floor:
Cost of Construction:$. //, 62 OD. Utilities: Sewer _Septic Building Height:
OVCENER/LESSEE:, - CONTRACTOR: - ;r
a
Name Name:
(.r�'��'
Address•.�//7 Company:
City: .dU� •Stater, Address: . a of
Zip Code:.3% y.9 � Fax: City: State: G
Phone No.. Zip Code:. 9.5�__ Fax:
E-Mail: Q C.11' ( Phone No-(-=) .�•Sloi'' �7
Fill in fee simple Title Holder on next page{if different E-Mall o VA S� � SI ��' OWA
from the Owner listed above} State or County License e e
2_
If value of construction is 2500 or more,a-RECORDED Notice of Commencement is required.
If value of HAVC is$7,M0 or more,a RECORDED Notice of_Commencement is.required.
SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name, '15• Name:
Address: / O! Address:
City: State: L City: State:,`
Zip:.339.f, Phone / �D 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 corifilct with any applicable Home Owners Assodation 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,!nail 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,wails,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 n attornev before commencing work or recording Notice of Commencement.
Signature of tra nt for Owner Signatu of Con older _
STATE OF FLORIDk4 I STATE OF FLORJQA %
COUNTY OF t- p COUNTY OF jj &
Swo to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presence or Online Notarization Physical Presence or Online Notarization
is tlay of V 20 by this,day of iJtSVPk � .20 Z J by
irrU �c3�yj S
Name of tersbn gstatement. Name of rson ' g statement.
Personally Known� /10 OR Produced Identification Personally Known ?0 OR Produced identification
Type of identification Type of Identification
Produced Produced
c
01
{Signature of Notary Public-State of Fi f Notary Public-State of F r �� x Notary Public Stat Is
ards
�Jr• Notary Public SO a of Florida yQ gunnie Merritt W Cox 10
Commission No. Y:' Bun Ye Merritt W c�rd ��,(( /_ M Commission H826
�� tdy Commission FEW®15Si0 No.l!I�'� �x'SP al Expires 09l071202
or h
Expues 09t07/20 4 ''+oi w
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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