HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 110
Date: Permit Number•
RECEI
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L- L 'L `[ - ._ Permitting DePa�ment
Building Permit Application St. Lucie county
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: fXX�►n �eLl
PROPOSED IMPROVEMENT LOCATION:
Address: "yl'S%C,tksoEq \ -4(Yr,1T SAZPSi Luc,-( G (-
Property Tax ID#: I 'S - rJQ 1 - 003'1 -b M-a Lot No.
Site Plan Name:C Block No.
Project Name: Gov\ Re_J�c�
DETAILED DESCRIPTION OF WORK: c C
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�p 5,1(�5`<� ->L���iyl/`l a%P9 `✓7 � S�i'i 0� C i�5f C�c�/c}�r�v. d �yin n r�. � �'KtS r.�-y
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 J Windows/Doors _ Pond
Electric _Plumbing _Sprinklers _Generator —Roof Pitch
Total Sq. Ft of Construction: 74 '/6 0 Sq. Ft. of First Floor:
Cost of Construction: $ 7, Coo,0 O Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name
Address: l4 p0 No(ZJ+, fie,-,sv,., C" w/� Company:
City: Ule 1 w State: C� Address: ` I (t , t ff �1 �Ul(l�
Zip Code:c),-7 S L Fax: City: ,
� �1 bi c h State:-I-L
Phone No. Zip Coder _ Fax: �CS�
E-Mail: Phone No 4:�_cw
Fill in fee simple Title Holder on next page(if different E-Mail - UY-MT+::'a� no'l. Cr)f1)
from the Owner listed above) State or County License ESL-Ya'ry--_,)Q9
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: fl
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 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 ou otice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signatur n ractor/License Holder
STATE OF FLORIDA STATE OF FLQJUDA
COUNTY OF COUNTY OF tYY1'Ple—CL&V-)
Sworn to(or affirmed)and subscribed before me of Swor�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 I y of k1 2OZ`y
L 1v`
Name of person making statement. Name of person making statement—
Personally Known OR Produced Identification Personally Known OR Prod Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public-State of Florida ► (Signature of Notary Public
irp4 pUB MARIA C DAMIANI
N� is
Commission No. (Seal) Commission No. F State of Florida
*Acton-GG 985044
My Comm.Expires Jul 19.202-
:-r
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
i RECEIVED _
DATE
COMPLETED
Rev.
5/6/20
CALI RNIA CERTIFICATE OF ACKN VLEDGMENT
Ftnotarypublic or other officer completing this certificate verifies only the identity of
e individual who signed the document to which this certificate is attached,and not
e truthfulness,accuracy,or validity of that document.
State of California )
County of 5cn iexml-A 1n 0 )
On Aun� Iq4�' 2021 before me, D�ffln 1"UUIC '
(here insert name and title of the offi er)
personally appeared R-aw wbl
who proved to me on the basis of satisfactory evidence to be t e person(/whose name(&are subs bed to
the within instrument and acknowledgA to me that h sh /they executed the same in his their
authorized capacity(i94, and that by hi her their signature on the instrument the personX, or the entity
upon behalf of which the personVacted,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
o COMM. #2344810 z
C 0 Notary Public-California X
Z San Bernardino County
WITNESS my hand and official seal. M Comm.Ex ires Feb.2,2025
Signature
(Seal)
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:
O form(s)of identification Q credible witness(es)
Notarial event is detailed in notary journal on:
containing pages,and dated Page# Entry#
The signer(s)capacity or authority is/are as: Notary contact: _
[] Individual(s) Other
Attorney-in-Fact [] Additional Signer(s) [] Signer(s)Thumbprint(s)
❑ Corporate Officer(s) __ _ruiea1 [..�
❑ Guardian/Conservator
❑ Partner-Limited/General
❑ Trustee(s)
❑ Other:
representing:
f,J alri,%•.'.ril�,'r „II(S1(11 I r`I r Vllt' \iifii,1 iy 17,1 rete'f I iri1
Ri Copyri,th1;110'?01x Notary Rotary 1'e1 Ho 41400 Iles Mollie}.IA',011 1 0',0! All H,qh!,N- 1 In•rri N1,o I heir 1017?? nea se eon tact your Au t 11 o r 1Je,1 Rese Iler to purchase e opies of this form