HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (�
Date: Permit Number: � 3- r
n UC y RECEIVER
_ p L MAR 3 0 2021
Building Permit Application Permitting Department
St. Lucie County
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Residential
PERMIT APPLICATION FOR Fence 64A "ee- -kNry3�e. �c�-F_)
°- •r-s= a. z=� -•'-�` �a r „N v x;r.. a.. }�a�Y feRut. cif af+j3Y'.`a�h da�Y�#C3 vs. �k1;
PROPOSE® IMPR®VEMENTLQCATION # �° �
_
Address: 47G aS gm-er-,6n AAu-e- Pt°e cc_ . El. 28R 5 1
Property Tax ID #: 1',6 ICE - JAS - oc-CD S - ogn-o - U Lot No.
Site Plan Name: Block No.
Project Name:
New Electrical Meter Second Electrical Meter
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: $ (� I0 ' d
_ Generator
1. ° v -2 Lii
_ Windows/Doors
Sq. Ft. of First Floor:
Roof
Utilities: —Sewer _ Septic Building Height:
Pond
Pitch
i
OUI/NER/LESSEE`^"� . , ,..
C04NTRACT®R,
NameTirw.e+hL, Qgn
Name:
r
Address: 1-160 otd l' L,45,�L�) S e xt IOC
Company:
City: UeM E ACk% State:
Zip Code: 3 II(oa Fax:-7 -SO4 7 R?,S
Phone No. -77a -5GL1 -?WO
Address:
City:
Zip Code:
Phone No
State:
Fax:
E-Mail: 4-tyw, CC)5e Into el- ccn rn-, j-_ r)ig-+
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License
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.
S . LEfVI ENTAL CO'NSTR`UCTI`ON
LLEN� LAW IN,FORIVfATIO.N'
w ,
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
i/Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
u/ Not Applicable
BONDING COMPANY:
Name:
✓Not Applicable
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 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 lender or aaalV ne before commencing work or recording our Notice of Commencement.
�1
csfignature Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Sfi, L..t
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
✓ Phical Presence or Online Notaz ion
Physical Presence or Online Notarization
this 3e day of wy%, 2021 by
this day of 2020 by
Name of person making statement.
Name of person making statement.
Personally Known J," OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary 5� No�Y IcState of Florida
L Jurkiewicx
(Signature of Notary Public- State of Florida )
Michelle
Commission No. Mycorp nHH011312
dr ExpueI pg/1 /2024
• `or 1.
Commission No. (Seal)
M1
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DATE
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DATE
COMPLETED
Rev. 5/6/20