HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l / (I
Permit Number:
' c M c o Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2)00 Virginia AvonU2, Fort Aiarca 1=L 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
Address:
Property Tax ID #: I I -'- Lot No. 17-
Site Plan Name: Uk y__ l ;v Block No. D�2_
Project Name: tA_&kU V\ C,_V2C --
New Electrical Meter A,11k - 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 4 Pond
Electric '_4 Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ fbL Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name k" �Y1 Name:
Address: fCV I TCA- L ME L-'
lCy
Zip Code: Fex
Phone No -$� 1 -i4�-c - E-
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above] State or County license C'_I=C� & `i V-13 _
If value of Construction is Z500 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: r Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name: 7Z
Address:
_
Address:
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 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
with lender or an attorneybefore commencing work or recording our Notice of Commencement.
,l
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF f LILU, L
/Physical
Sworn t (or affirm d) and subscribed before me of Presence or Online Notarization
this j/_ day of , 20 �y II
Name of person making statement.
Personally Known v/ OR Produced Identification
Type of Identification Produced
4
(Si ature of Notar Public- St a of Florida)
Commission IN JULIE
�VJMDCAMY
I e of Flvric'a
`= Commission # HH 49824
aF My Comm. Expires Oct t, 2024
lorded through Natiora! Notary Assn,
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DAfE
RECEIVED
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COMPLETED
Rev 10/12/21
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