HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 60 r3.1 Permit Number:
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91T. EMU DEC 0 7 2021
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BuildingPermit Application St.Lucie County
p p Permittin
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: palm-,
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Address: 17-19 9% NU) I � w, C�. . ti'C�)LI�Y� C�.d FF� . �Jy
Property Tax ID#: HLilrz)•60-6-6040 -6061 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK: s
- oo� Skin -f- A 4d 1121C
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION: '
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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 X—Roof lob-- Pitch
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Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 5 ,sd Utilities: —Sewer _Septic Building Keight7
OWNER/LESSEE: CONTRACTORS „$
Name I Name: FrQsrac LQrro
Addr : nn W. Company: O T� 4
City: lAll!h1 0 li a State: :,�L„ Addr s•
Zip Code:43y990 Fax: City: CJ n h &A r 19 State:-R.
Phone No. E- Zip Code: Fax:
Mail: Phone No 5(01' gSrJ-I 9-7a,
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Fill in fee simple Title Holder on next page(if different E-Mail miL o+ .- Pc&mY- oac.co %
from the Owner listed above) State or County License I'-5';-1231,32?)g62,
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. j
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-SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: � ,ti ;�
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
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 granting a permit will authorize the permit holder toy 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 inIpaying twice for
improvements to your property. A Notice of Commencement must be recorded lin 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 our Notice oflCommencement.
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Signature of Owner/Lessee/Contractor as Agent for Owner
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STATE OFFL
CPWbM 1�1�h COUNTY OF
Sw (or affi d nd subscribed before me of Physical Presence or Online Notarization
this ay of o1 202 by
Name of person making statement.
Personally Known V OR Produced Identification
T e of Identification Produced
(Signature of Notary Public-State of Florida)
Notary PubfiC State of Florida
Commission No. (Seal) TON AdrienneTheeck
My Commission+HH 058304
a p ExM: 10l28l2024
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev 5/20/21
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