HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `� I
Date: Permit Number: 4 `
,�����li��..,,o�'L�1��L� `': I j RECEIVED
Building Permit Application DEC 3 0 2021
Planning and Development Services I St.Luce County
Building and Code Regulation Division Commercial Residential Permitppg
2300 Virginia Avenue,Fort Pierce FL 34982 I ILA
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
I I
PERMIT APPLICATION FOR: }q lq dd
:PROPOSED IIVIPROUEME,NT LOCATION r, LL
Address: SLUR VJ 11 G1S''(1N 4\1 C, Po(-4 P i ence 3 4Ct51
Property Tax ID#: �J y k- U 3- ( co t- CIC30 Lot No.
Site Plan Name: /+ I Block No.
Project Name: rOLlAdhL Y, I
I I
DETAILED DESCRIPTION OF WORK h£ , r
i a shryA �f coy Or fi k'(:'e wk� � C' l � M'ti-ca
dr S 1 �w S hi
New Electrical Meter Second Electrical Meter (affidavit requii ed)
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 6 Roof Pitch
Total Sq. Ft of Construction: � W Sq. Ft.of First floor:
-1 -1 60
Cost of Construction:$ �' 1 , 1 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE t� =CONTRACTOR:
Name fS e_ Name: h.� ��
Address: 5$0$ IL1�la�r�64 A-V2 Company:
City: fr Ptcoc-e_ State: FJ_ Address: 3T?( 6W A-Ic c E
Zip Code: 3c4q 5 i Fax: City:T S L 1 State: PC—
Phone No. LOUR X1 [- 'I 156a E- Zip Code:c���l 7 Fax:
Mail: Phone No �� _ i.D �17�! 70
Fill in fee simple Title Holder on next page(if different E-Mail ( t Pls'.�krf� C cam
from the Owner listed above) State or County license_ Cr i
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
i
If value of HAVC is$7,500 or more,a RECORDED Notice-of Commencement-is requiretl.
i
1
'I
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION w5T
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable _
Name: Name:
Address: Address:
City: State: City: I State:
Zip: Phone Zip: I Phone:
I I
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address: I
City: City:
Zip: Phone: Zip: ('Phone: l
I I
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 attornev before commencing work or recording our Notice of Commencement.
i
Si nature of Contractor-or-Owner Builder as applicable
STATE OF FLORIDA
'COUNTY OF
Swo o(or aff' ed and subscribed before me of Physical Presence or Online Notarization
this,:,day of 20L�by
LV\Wlao �c �
Name of person making statement.
Personally Known OR Pro d Ide ification
Type of Identi cation Pro edi
!
(Signature of Notary Public-State of Flori a
Commission NO. (seal) KAREN S. NIELSEN
'�fi"aYPOe<<;State of Florida-Notary Public
*_ Commission # GG 207484
r�oio`' My Commission Expires
June 12, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev