HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ill b-I Permit Number:
1951T. WO_ RECEIVED
NOV
guilding.Permit Application 2021
St. i.uda �ounEy
Planning and Development Services ri9
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:
C-
PROPOSED IMPROVEMENT LOCATION:
Address: 32.18 S. Lftkf fiPu) .0.ir -17'7267— . LAchinsrm ks CIA ;rL
Property Tax ID #: 14Z..r r CD b G 0 Oct 2. - OD O - Lot No. -
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
_ Electric _ Plumbing —Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $ Lill O
Windows/Doors Pond
_ Roof Pitch
Sq. Ft. of First Floor: -
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Dcr rr_i`- (A sV rbh a 414r)
Address: 321S w �1r02
Name:
'NPan
City: <�U nSr� l'5 r� nnl State: R
Address: � 5 ' NtiT �nrmeW
Zip Code: 3y 9' Fax:
City: Rr�r�` SI- Lu ��, State: t
Phone No. ' -li7.- y 1.rd:-yHIn ' E-
Zip Code: ;'-I q KCv Fax:.
Mail:
Phone No
E-mailtr5�-rVi Min n � r- (a lnC��'►'YZ ad �.. CG�n
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License AG
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 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 commencine work or recordine vour Notice of Commencement.
Sig ture of Ow er/ Lessee/Contractor as.Agent for Owner
STATE OF FLORIDA
COUNTY OF 5k, 1 -jc.c
Sworn to (or affirmed) and subscribed before me of -OC Physical Presence or Online Notarization
this -IS day of 0 <0r 20k. by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced sc L 01_
(Signature of NotaryPublic- State of Florida)
Commission No.� d Sea ANNAGIVENS
p�blic of =lorida
: Notary -State
^` <: Commission HH o86359
Expires ian 28.2025
MY Comm.
" through National Notary Assn.
Bonded
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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DATE
RECEIVED
DATE
T-1
COMPLETED
Rev 5/ZU/Z1