HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED j
Date: 12/66/2021Permit Number: 1 S
Ov.
O
p Building Permit Application
Planning and Development Services
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:
PROPOSED IMPROVEMENT LOCATION:
Address: 4-7 Xa.0 Lt LL br'i Je-JeASeA 6ec ,� , �: L 3 LIYS 7
Property Tax ID #: N 5 l I -- S I I— 0 0 2 2— y (7 — 5 Lot No.
Site Plan Name: �Block No.
Project Name: Pool Peri.� ever Rae
DETAILED DESCRIPTION OF WORK:
ArPPr0X('1VJl k l eo'KekEmce w4k" W S i✓�
a
-F G 051✓1 iki 0. tos d"Y0 aq n a I'l C i �e
1 4- S e ?001 0- 0 -7 4 -ad vvi t ed se of a
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 _ Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Ft of Construction: I 0 L Sq. Ft. of First Floor:
Cost of Construction: $ a 10 Q 0, 0 0 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 6w e-4 E:n- der '
Name: ttlhe(-U(cke(
Address: Ra Dr.
City: Se n s en ecLr_ k State: FL
Zip Code: 34957 . Fax:
Phone No. '7 72,- 6I 6 -2 94 I gOq-Gbq- 9/,0 E-
Company:
Address:
City: State:
Zip Code: Fax:
Phone No
Mail: 6L6Ve
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License
It 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', PRSTRUCTION LIEN LAW INFORMATION
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name: Je -5
Address: fo &-x.lqqW
City: Des Ao i a e State:
Zip: 5o306 -3411 Phone:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
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 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 commencine work or recordiniz vour Notice of Commencement.
Signature of Contractor - or - O der as applicable
STATE OF FLORIDA
COUNTY OF I_ nd ion r ver-
/
Sworn tq (or affirmed) and subscribed before me of v Physical Presence or Online Notarization
(n day De Cerra
this of — , 20QI by
Name of person making statement.
in
Personally Known d OR Produced Identification
roduced
Type of IdentificatTO
CIA M-P (YI a P U44A
(Signature of No Public- State of Florida)
Commission No. a 3 (Seal)
'y"W �; , CARMEN LISA RUSSO
r=. NotaryPublic- StateofFlorida
;'�W-4
o� Commission N GG 182937
��r '' My Comm, Expires Feb 5, 2022
Bonded through National Notary Assn.
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Rev 10/12/21