HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
9Uo L���1�QCR__ RECEIVED
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Building Permit Application JAN I g 2022
Planning and Development Services st. Lucre County
Building and Code Regulation Division Commercial ResidentiaJrmittin
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: iOZ cean ,c• e c �� 3`l
Property Tax ID #: Lksoz - %lO2 - Cco -o - oo4S Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:,,
1 %J' '%� nc, 00,r- a aT
New Electrical Meter
Second Electrical Meter,
CONSTRUCTION INFORMATION:
(Affidavit required)
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: Sq. Ft. of First Floor:
Cost of Construction: $ -2- 2_00 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name V ci, ) .�ec,-A r: c-e.
Name: L %a i! —5
Company:im� (�en5�c�sc��on
Address: "ZO-1 tkoocAo
cre-s- L' �na`1 e-z
Src
4-
Address: to\o'Z So.,A)n Oc mn l)Fr •
City: , le s,S, n State: r- 1
Zip Code: "S'5r- Fax:
Phone No. `1'7Z- S21 -Z3SR- E-
City: J ,C;Ae c-
Zip Code:
Phone No{S6k- -16'8
E-Mail %Y4 o !X AV4
State: F
Fax: 561- 93S-iZ-�l
-$1`k86
- CoY&Ir - Co FM
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License QGQ IS L" 19
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.
J SUPPLEMENTAL CONSTRUCTION LiEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: ✓Not Applicable
Name: eska s Name:
Addreess:_o Y9Fte Address:
�
Cfty: Ivor im M ,T State: - J City: State:
Zip: S-, 409 Phone_SU - 1- 72 $o Zip: Phone:
FEE SIMPLE TITLE HOLDER: I/ Not Applicable { BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
V VVrvCr</ Aviv i riHu Un AN IUVI I: 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.
5t. 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 Noticeof 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 vniir nlntirp of (nmmanrcmont
Signature o on ractor- or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of Presence or Online Notarization
_j?�`Physical
this day of 202-by
Name of person making statement.
Known
Personally Qr OR Produced Identification
s;�Y?fit• DIANAVELASQUEZ
Type of Identificatio Pro uced
*; *- MY COMMISSION #GG 933705
EXPIRES: November 21, 2023
�Qpg' Bonded Thru Notary Public Underwriters
(Signature of ry ublic- State of Florida)
Commission No.6 693?s(Seal)
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