HomeMy WebLinkAboutBUILDING PERMIT APPLICATION 12-9-21"l
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED p;? /V
Date:
o
Permit Number:
RECEIVED
DEC 0 9 2021
St. Lucie Fcounty
ermitting
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial
CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Residential X
Address: 24 �5 JOHY5160 RO&D , Fowr F"tE12QE E FL 3y 951
Property Tax ID#: 1334-5oI- OOL4?-- 000'3 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCR,IFTION OF WORK:
iX 5+
COW'E SIZEJ4) 04 12. X 12. PAF / 2
1 Cti0NC2El"E 3L_'A-9.
New Electrical Meter 4 CS 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
YCElectric XPlumbing _Sprinklers _Generator Roof c3/JZ Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: /050
Cost of Construction: $ Woo Utilities: —Sewer —Septic Building Height: 12'
Im
OWNERAESSEE:
CONTRACTOR:
Name A- How ClotizaaZ
Name:
Address: Zq6rJ' .101-1RISTZSI.1
Company:
Address.
City: F612'r P1 1:-:24E State: FL
Zip Code: 3� C! JrJ Fax:
City: _ Stater
Phone No. �-�$?q — I y Qf E-
Zip Code: ax.
Mail: L t?'tLE
Fill in fee simple Title Holder on next page (if di eiQnt
Phone No
E-Mai�'�
from the Owner listed above)
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 CONSTRUCTION LIEN LAW. INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: _
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
State
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
Citv:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
Not Applicable
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 attorney before commencing work or recording vour Notice of Commencement.
04-0-01 . 0i'tZ., A-t4-
Signature of Contra r - or - Owner Builcor a plicable
STATE OF FLORIDA
COUNTY OF S% LLAZIF
Swop} to (or affi ed) and subscribed before me of _ Physical Presence or Online Notarization
this Z_day of 2QJby
-
Vl"h , 1Z—
Name of person making statement. /
Personally Known OR Prod Id ' ition ✓/
Type of Ide ification o, uced (o�
(Sig re of Notary Public- State of Florida)
Commission No. (Seal) KAREN S. NIELSEN
.``aYPu'. Public
;=os" a��;State of Florida Notary
# GG 2074e84
-, *= Commission
(`/ly Commission Exp
0f"°+ June 12, 2022
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Kev 1U/11/21