HomeMy WebLinkAboutBuilding Permit Application:,;
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ,\ » Permit Number:
91T. d 7UC ram! RECEIVED
O
AUC19 2021
Building Permit Application
Ft. W010 county
Planning and Development Services Permitting
Building and Code Regulation Division Commercial t Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: ii L1 O S 1A 5 I-k W -,'
Property Tax ID #: 9-q 3 L\ _ 3 L_t 1 — 0 O O 1 - n ?j O Lot No.
Site Plan Name: I Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:.,`
r l S 1 Jo �,�,� �'-� ICU �,..y A=rccc.` d4e__ .
New Electrical Meter Second Electrical Meter (Affidavit required)
CO NSTR U CTI ON; I N FO R MATI O N : ,
Additio I work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
— Electric AlFrumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 1 Q; O Q Q 040 Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE :
CONTRACTOR:
Name �(� 4 rk Prr-<<c
Name: `r(r'eot,t&'c
CacJ- Coe--, ,J �a.•JEfe
Address: G Ll0 \'I-JL %
Company:
�De- J tN'ke � r1
City: H o l State: f
Zip Code: 3 16 �L 3 Fax:
Phone Nol f) 0 153 3 'k zg 9
d1C E-Mail:6rzc.C$�C�� ✓r�<< � o tr d -C',v+1%
Address:
(2A
City: r w-�- I�� ��� State:_�L
Zip Code: 3 L401 Fax:
Phone No (7-)_0 SN 2-
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail -�-d G�sc�lc,Go��-g e-�' o�y��.; (,nor►-�
State or County License C (.' C l 6a
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.
rS
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: -
DESIGN ER/ENG I NEER: _ Not Applicable
Name:
Address:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
BONDING COMPANY: Not Applicable
Name:
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.
-1I 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 lendpp-oli an attorney byre commencing work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
�-lc-
COUNTY OF
Sworn before
Physical Presence Online Notarization
(or affirmAd) and subs ribed me of or
this ��day of r,—yt- 20 2.1 by
,
Name of person making statement.
/
y
Personally Known OR Produced Id t'fication
Type of Iden 'fi tion Produced
(Signature of Notary Pu lic- State of Florida )
�r Notary Public State of Florida
Commission No. G & 2 $ 7 -2 C( (Seal) _° Colleen Sue Hayes
;2
My
Commission GG 287729
Expires 0311512023
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