HomeMy WebLinkAboutBuilding Permit ApplicationI
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTb II
Date: ti1bc' Permit Number:
llo WFICH16 RECEIVED
NOV 0 5 2021
Building Permit Application St. Lu 'eCounty
Planning and Development Services P rmitting
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: TO)y 140M Rwo C-OrP6
Address: VOO L&,n4 1J1i)2 �iQ , For-E 1 lereg , R SglQ 6 1
Property Tax ID #:
Site Plan Name: NIA
Project Name: /IMoYl
I
New Electrical Meter K)/A Second Electrical Meter rA (Affidavit required)
Lot No. 23 £ 2
Block No.
t
w,
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: $ 24 2 CJ �
_ Generator
_ Windows/Doors _ Pond
Sq. Ft. of First Floor:
_ Roof Pitch
Utilities: —Sewer —Septic Building Height:
� •„ �� .� 1 e..x',p ;5 'l kt�fi?RY ' # b1Me�•r. i�}k e��G'�?C,ti AT i $ 1 jlic f`htaJli"a �}+ 9:, iC424 �k1 E �;
OWf�ERN.
�' q,.,a..:. t SVJ; t Y' ^ A�.�'�4 fF� t•i13�N `� $� �'�..:' `>F t' 1✓1! ,1} c �"�U4 ..1,4tV } � 1{`.,
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..,.tar;
Name F fix ertmoyl
Name: R66ei r._
Company: G �h ri Q
Address: 1:4.7 9, Hlmocf_ '(�+-
Address: SL-{Oq d>2 9"In2
City: State:
Zip Code:34Q5l Fax:
City: &-'' t LyC i r— State:
6
Phone No. — E-
Zip Code:349 Sq Fax: -7q2 Ste? 1
Mail: �—
Phone No 2 �` �'t�q
Fill in fee simple Title Holder on next page (if different
E-Mail iZu to , zjccwol'�
Stator County License .-G�
from the Owner listed above)
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.
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��SUPPI��M�NT�AL�CQNSTRU�T�It3N,,�L1EN � Ulrr�t�t�0'RIWIATION
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DESIGNER/ENGINEER:
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: �o� l f'a �a✓r.�2aU
P E. ��► •
Name:
Address: ��2
.i�r. IU1
Address:
City: Zephyrh;IlS
,,..LJn�-�
State: �l•
City: State:
Zip:3y� UZ Phone &►3
-�c�n 531�1
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 commencingwork or recordingour Notice of Commencement.
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1
5/20/21
/
Signature of Owner essee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF �I • Lue1p
Sworn to (or affirmed) and subscribed before me of � Physical Presence or Online Notarization
thisZ� day of l�'