HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /2 /Q / zv2-i Permit Number:
9Vo PReEIVED
MyP0-0ll- DEC 0 2 2021Building Permit Application St. Lucie County
Planning and Development Services Permitting
Building and Code Regulation Division Commercial Residential l/-
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:: �'C .f L O
Address: % 0 PALtPic- !a+/e -.PI/54r-,e
PropertyTax ID #: -c.kz wdoA) r ,plc VAI � 34xk 3L/ Lot No. r c
`Site Plan Name: Block No. 3%
Project Name: —jd�--a2-e. &®Acre
DETAILED DESCRIPTION'..OF. WORK
J�U ��or �� r� i'�'ti •� c c,-roa- �/� c
S Lq - &0-0 nT 11, G �,,,� rf 7 'O a /` RJ�G-!L, t5 Al RJcJI+<? K l Z
�iLi�:50� f%�� D�� %� x_�0
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
Electric _ Plumbing _ Sprinklers _ Generator
Windows/Doors _ Pond
_ Roof Pitch
Total Sq. Ft of Construction: 00 g-0 sy OC' Sq. Ft. of First Floor:
Cost of Construction: $ M 22K Utilities: —Sewer _Septic Building Height:
E4
OWNER/LESS'EE, _. .,
CONTRACTOR: _
Name "t C4 cc_ S _ Igl-A QJ^
Name:
Address: 5 OC/A lloy-e-
Company:
City: �; r f- State: P,
Address:
Zip Code: 4 19S 1 Fax:
City: State:
Phone No. z 2 ZkY/ E-
Zip Code: Fax:
Mail: to r c - fin Q bell s , ,• tip-
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is requires. I
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required. r
SUP.PLEMTAL:CONSTRUCTION.LfEN LAW'INFORMATION - .
,.-EN- ,
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name: &W Z-o Nc 13
P A rt L
Name:
Address: Go u-cs 4 .V<. I
Address:
City: < I �,.
State:
City: State:
Zip: Phone
Zip: Phone:
a
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 1pnriar nr an attnrnpv hpfnrp cnmmpncinL work or recording vour Notice of Commencement.
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA •
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this 4g_ day of e_V , 20.=?[ by
L-
Name of person makfng statement.
,, /�
t
Personally Known OR Produced Identification •
Ok-- "& .
Type of Identification Produced
a -A( a. �.
hm
(Signature of Notary P lic- State of Florida)
.S py pU r
;=o..•••.•��; AUDREYB.HUMPHREY
Commission No. (Seal) *: MY COMMISSION # GG 300817
EXPIRES: March 6, 2023
?. "' t i; • Bonded Thru Notary Public Underwriters
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DATE
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DATE
COMPLETED
Kev 15/12/21