HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
1 �_O
Date: 42--/1-2dZY Permit Number.
FRECEIVED
� 2021
p ° _ Building Permit Application
Planning and Development Services y, ��rmitting
Building and-Code Regulation Division Commercial Residentla
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION. FOR:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID#:� ) —' D� l VU��+��" Lot No.
Site Plan Name: �r Block No.
Project Name:
DETAILED DESCRIPTION OF WORK: .
* �17
- L T z �
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 _Windows/Doors _Pond
Electric _Plumbing _Sprinklers _Generator Roof I -Pitch
Total Sq. Ft of Construction: /0/ Sq. Ft.of First Floor:
Cost of Construction: $ Utilities: Sewer _Septic Building Height:
OWNER/LESSEE: w CONTRACTOR.,
Name 1)� V" Name:
Address: �7l��rnl ,� liW6 l�✓ Company: rn� � CTIGII
city: Ili® State: Address: _2' '., Atlan- f,
Zip Code: Fax: City: State:
Phone No. �'/��'� �� E- Zip Code: Fax:
Mail:bE mo-F-ro 6A rtfi ..C6M Phone No
Fill in fee simple Title Holder on next page(if different E-Mail AjUq&6S eow3T YemA)(z 6/wl (ww
from the Owner listed above) State or County Licensees 3 ,2?
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: __eof Applicable
Name: Name:
Address: 44 Address:
City: State: City: State:
Zip: P one Zip: Phone:
FEE SIMPLE TITLE H _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
w'th lohdpr or an Attorney before commencing work or recording our Notice of Commencement.
Sig ature of Contractor-or-O ner Builder as applicable
. 4
STATE OF FLORIDA
COUNTY OF
Sworn o(or affi ed)and subscribed be ore me of Physical Presence or Online Notarization
this 1 day of 2 by
U mtx�� an4
Name of persld making statement.
Personally Known OR Produced I .ntification KAREN S. NIELSEN
;_° ;State of Florida-Notary Public
Type of-I' tification r duced =* *= Commission # GG 207484`
My Commission Expires
AX June 12, 2022
(Signature of Notary Public-State of Florida)
Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 10/12/21