HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �\ �, a1 Permit Number:
97.
. Was RECEIVE,)O
� _ _�__.._:_ � • :- Building Permit Application JUN ® Y 2021
Planning and Development Services Pe
l lq9 Oepart'ment
Building and Code Regulation Division Commercial Residential Lucle county
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION: \
Address: i W 5 Jr P� 1' Caov, L O w 1 e--) eQ\- ►" ,� Lns r)N >,pm6 iFL Sly I Jr%
Property Tax ID #: 35-02 - 7CQ — <2000 �4) Lot No.
Site Plan Nameg, c,ouw t� i�.`�� t,j��4? 7 O� 3�7 'Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ A� / C---) c �)C Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Uric
Name: G�L�JY.2'r �0►�1�.-t
Address: �fn S f�� I c. v ee 112c-,
Company:
City: 36N State: j�
Address:
Zip Code:_:�/q 9 �� Fax:
City: State:
Phone No. 2 %� ��r, C7
Zip Code: Fax:
E-Mail: Q mmi t .&O
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION -
DESIGN ER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory. structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie Countv and Dosted on the iobsite before the first insDection. If you intend to obtain financing. consult
with lender or an attornev before commencing work or recording vour Notice of Commencement.
gnature of Ownf/ L$ssee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORA
STATE OF FLORIDA
COUNTY OF 5�,-Jc.�P
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Presence or Online Notarization
this day of Sytinl , 2021 by
this day of 2020 by
De,�,,a, CS taw• g P%
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 Nota ub -: s-qf FloridaD} AN A, Gftfitl
Public •State of Florida
(Signature of Notary Public- State of Florida )
Notary
Commission No. *64 ` C mlS��sion # HH 086359
Jan 28, 2025
Commission No. (Seal)
,. My!Expires
Banded through National Notary Assn.
PLANS
VEGETATION
SEATURTLE
MANGROVE
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.