HomeMy WebLinkAboutBuilding Permit Application • � � • 1d 4 8S
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (�
Date: Permit Number:
97. RECEIVED
(�L,UMTL NN OCT 2 8 2021
L- L L, L: L L tz ---K--
Building Permit Application Per Smitting Departmentt. Lucie countv
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
PERMIT APPLICATION FOR: eke f Oi1
PROPOSED IMPROVEMENT LOCATION:
Address:d 1 S V S \ -R(zo-M L UGC( G L.
Property Tax ID#:. 3 4 115 - rJ01 - 0O3'1 -(S(C3-vL Lot No.
Site Plan Name: Block No.
Project Name: 61 tl_c� �_1Cx OA
DETAILED DESCRIPTION OF WORK: n
�t St��/� rZ/ tc s-+, .�a ec� ✓>'c A"►f e�S pn �4s C,y,�o-�� �` Cc�.+�rt �U arc c
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _ Pond
_ lectric _ Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ /(_)ov,, o d Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name i 4-0-.0- Er.e.2 c� Yl,�,z;�a rZr,o. Name:
Address: 14bo N�2uti �2�•sv�^ �� "� Company: 5i6j^5
City: L) State: Cfj Address: %7Yt6 f4 / A-e-
Zip Code:9, 7 >7 L, Fax: City: t 415 �� )3c'u c 4- State: F�
Phone No. Zip Code: 33y0 Fax: 1�13 -902-9086
E-Mail: PhoneNo613_g0'7' 5000
Fill in fee simple Title Holder on next page(if different E-Mail 6-4—
from the Owner listed above) State or County License 8 00C)OO as q
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.
r
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: — Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address: n
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: n Address: }
City: T 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 o otice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signat o tractor/License Holder
STATE OF FLORIDA STATE OF FLO DA
COUNTY OF COUNTY OF K[IbOpzeam
Sworn to(or affirmed)and subscribed before me of Swo
rp to(or affirmed) and subscribed before me of
Physical Presence or Online Notarization Physical Pre ence or Online Notarization
this day of 12020 by this f_�ay of J_tkU 202orby
'X/Z
L 1 y 1 I�XY�
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public- State of Florida ) (Signature of Notary Public-Stat oftI;a ) MARIA C pAMIANi
Notary Public-State of Flo'id
5044
Commission No. (Seal) Commission No. ye��<: �Q mmi.Expires
s J t 19,
( '''� —;R.; m,Expires Jul 19, 0
Borded through National Notary PS
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.
CAL11 INIA CERTIFICATE OF ACKN I/LEDGMENT
A notary public or other officer completing this certificate verifies only the identity of
the individual who signed the document to which this certificate is attached,and not
the truthfulness,accuracy,or validity of that document.
State of California , )
County of -��1n Pifl6l in L )
On JUnt n4` U✓21 before me, Dffln S ff, daw PulaIc
(here insert name and title of the offi er)
personally appeared R.awa. Rwb►
who proved to me on the basis of satisfactory evidence to be theerson(el whose nam is are subscribed to
the within instrument and acknowled��to me that he sh they executed the same in hislt�heir
authorized capacity(A and that by his their signature on the instrument the person4, or the entity
upon behalf of which the person(/acted,executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the
State of California that the foregoing paragraph is true and correct. DEANNA R. SPEER
COMM. ##2344810 z
1 Notary Public•California o
WITNESS my hand and official seal. z San Bernardino County
My Comm.Ex Tres Feb.2,2025
Signature l
(Seal)
Ll
Optional Information
Although the information in this section is not required by law,it could prevent fraudulent removal and reattachment of this acknowledgment to an
unauthorized document and may prove useful to persons relying on the attached document-
Description of Attached Document Additional Information
The preceding Certificate of Acknowledgment is attached to a document Method of Signer Identification
titled/for the purpose of Proved to me on the basis of satisfactory evidence:
0 form(s)of identification 0 credible witness(es)
Notarial event is detailed in notary journal on:
containing pages,and dated Page a Entry N
The signer(s)capacity or authority is/are as: Notary contact:
❑ Individual(s) Other
�] Attorney-in-Fact LJ Additional Signers) [_] Signer(s)Thumbprint(s)
❑ CorporateOfficer(s) tai�i5i L._�
❑ Guardian/Conservator
❑ Partner-Limited/General
Trustees)
❑ Other:
representing:
Name(s)of Peison(s)or tnotypes)Signet Is Represenung
Q Copynghl 100'XOIS Notary Rotary.PO l 41400.1)e,Moines.IA',Oil I OiO7 All fogh• Numbw 101771 Please rontacl your Authowed Resellor to purchaser optes of thu form