HomeMy WebLinkAboutBuilding Permit Application�-L
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 �°� I a 1 Permit Number: a� a3 Gq`kq
RECEIVED
MAR 1.9 7021
Building Permit Application Permitting Department
Planning and Development Services St. Lucie County
Building and Code Regulation Division Commercial Y Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: C. a
1►Y1
PROPOSED 'IMPROVEM'ENT10CATION:
Address:
Ivew tiectricai Meter Second Electrical Meter
CONSTRUCTION INFORMATION:10
X_
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: _ 2 YGO Sq. Ft. of First Floor: 2Vtll0
Cost of Construction: $ 1 ge Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE::`CONTRACTOR.
;>
Name lld v1 DL �iov� �..4.+ 6e,
Name: {f f AJA
AA
Address: 70 7 if' Orl�� djgTA �jy�
Company: W.d . rrl`
/
City: p, State: f-
Address: SS/d Hie�ar� �iR.
Zip Code: 30jSZ Fax:
City: ?Iec%
State:`
Phone No S��/- 217^ 1$11 r�
Zip Code: 3 y4az
Fax: N/q
E-Mail: /�i_ o�,�,�,,A„` ��cE
Phone No 7iZ V40
9� 2_
Fill in fee simple Title Holder on next page ( if different
E-Mail ii /oRi 1,
ro 4 & eaMA.,J
from the Owner listed above)
State or County License C'l3C /2 3
If U2I1 in of
--- -• •-•-•-i •+ ••�-..+•••��.� .wr Z �' a•vnnual....MUM IS requ:rea.
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:.ZB `T &1�i7P��tl�
_
Name:
Address:
Address: 5-/7 Sw d W /<e H AV e
City: Pert- sr
Zip: 3y4 S3 Phone 772- ggo
State: -L
S7Dc
City: State:
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 attornev before commencing work or recording vour Notice of Commencement.
Sworn to (or affirmed) and subscribed before me of
X Physical Pr Bence or Online Notarization
this LL day of 0�� by
c
�Ir��sF
Name of person making s"ment.
Personally Known OR Produced Identification
Type of IcIggntification V ,,
Sig natureoftIacto Lic Holder
STATE C FLO ID
COUNTY OF 4—
I�4Jll'.fs,o
Sw rn to (or affirmed) and subscribed before me of
Physical Presence r Online Notarization
this + day of 2� by
1 l n A c ��
Name of person making staf-rk- ent.
Personally Known OR Produced Identification
Type of IdeAification - _ , - ^ ,,
(SigrTaUire of Ivotayy Pelpli
�l
Commission No.�
-
ignatdre of Notavq Plic- te_of Florida
•'+1r? C STIAPi EAGLE
�), ,( t �'-;
mmission No M40'. N3 307,
�•; GG 023
, P`,` EXPIRES: March 4, 2023
��`'
�" CHRISTIMi EAGLE
of MRIWMISSION�GG307489
�o EXPIRES: March 4, 2023
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