HomeMy WebLinkAboutBuildin Permit ApllicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1 ^�
Date: ) 1' ���) Permit Number 1 I I 1 0'�
9U Wo RECENED
O N
- ° 0 . "` Building Permit Application NOV 3 0 2021
Planning and Development Services Permitting Depertnient
Building and Code Regulation Division Commercial Residential St. Lucie County
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED mP,ROUEM,b LOCATI`.ON
Address: IC690 S cw--9" DA✓E SAC* . EL Flta�
Property Tax ID #: 4s%)1 — 516 — omo & Lot No.
Site Plan Name: " Block No.
Project Name: TSLfi-(3� C42 s C4>0
DETAILEDDESCRIPTIONOF 1NORK: ti
Clix 104 201; , oR4 6o�—,226' Q ,`b��1 IIo, �,.I T�S" 3oS , / � S_9KI/& C Ii
New Electrical Meter 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
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $_� , 60
Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: _ ='
CONTRACTOR:
Name I5UA70 h C4 (t9��l J&VJLLSJ
Name: 179urit
Address: /MAD �z = �
Company: g
City: �!Ccw st R1CV41 State: =Li
Address: O f
Zip Code: Fax:
City:77
a/b9'ol(L4� �.vllC State: �C,
—Q\
Phone No. E-
Zip Code: 3 Fax:
Mail:
Phone No 6 — 6 2 — ->
Fill in fee simple Title Holder on next page (if different
E-Mail G t Cd;p*
from the Owner listed above)
State or County License G ( C. 1,Y? 606 2—
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 CONSTRUCTIONLIEN :LAW INFORMATION;
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: F%oXI b A- CoAl Sc)LZ"119G I=GUC* Name:
Address:I4 ou] L•b-VA sfy'eek SgII— Address:
City: Lao LAB 11244YoA)i State: ?—L— City: State:
Zip: Zlk:52— Phone_Sr,.j1_9f3_ II5Z Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citv:
Zip: Phone: _
Not Applicable
BONDING COMPANY: Not Applicable
Name: _
Address:
City:
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 [ 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 commencine work or recording vour Notice of Commencement.
O'•
Sign at e.erO er/ Lessee/Contractor as Agent for Owner
STATE OF FLORID�LjeZ��
COUNTY OF
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this day of 9) 2�7 by
i e—
Name of person making statement.
Personally Known OR Prvdtl ed Identifi ation
Type ofaIntification Pro ed "
(Signature of Notary lic- State of Flori a)
''•, AUDREY B. HUMPHREY —�
`.4Y PU
Commission No. (Seal) ° "%.� MYGOMMISSION#kGG300817 I
_: .
6, 2023
, ;
A EXPIRES: March
Notary Public UndotVh1,scs
Eonded 7hru
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Rev 5/20/21