HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED t�
Date: a`� Permit Number:
RECEIVED
JAN 2 4 2022
Building Permit Application Pt,Perm County
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
PERMIT APPLICATION FOR: Sh i n rD Q
,,PR
QPOSED IMPROVEMENT LOCATION:'
,�.
Address: /n O (_);(A- o n Ox-1 �i Sf✓ .
Property Tax ID#: 3��Cl - S�Z�" d0lo `00,0 - s- Lot No.
Site Plan Name: /�� Block No.
Project Name: Vie It Jw 1 K.�,0d,9n t✓e__
DETAILED D'`E8CRIPTI6N OF,WORK u
a
Fes., 26 e4 • s-u ega . 12„®e, f� 6"-oc o -�►. R�,A,,,,��e•�:
New Electrical Meter Second Electrical Meter
.CONSTRUCTI,ON'INFORMATl_ON ` .
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 Vnd Roof 3 /.Z- Pitch
Total Sq. Ft of Construction: 1 2gZ Sq. Ft. of First Floor: �C2-
Cost of Construction:$ 12;o j (000 Utilities: _Sewer _Septic Building Height:
OUVN E,R/LESSEE CONTRACTOR:
�T.
Name CI`n 'IW_0 L, ). Name:
Address: 5U ,(�'Vsf 006i j I -POGY4 Company:
City: ij m 6 4m State Address: E 01 I
Zip Code: 3 u C) Fax: City: f�L_ St e
Phone No. 1`1 I Z Zip Code: SL4�) 2 Fax:
E-Mail:, n 17'1 1 Phone No`�� �33 �Ci
Fill in fee simple Title Holder on next page(if different E-Mail cc I n(Al r00
from the Owner listed above) State or County License 032!Sl
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.
SUPPLEMEL.CONSTRUCTI"ON LAW LIkEN" IN NTA FORMATIQ'N
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone 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 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 an attorney before commencing work or recording our Notice of Comme cement.
V
Sign re of Owner/Lrssre/(forkractor as Agent for Owner GTE
Contractor/License Ho der
ST TE OF FLORI FLORID
COUNTY OF .VVL (-I COUNTY OF '�
Swo No(or affirmed)and subscribed before me of Swor o(or affirmed) and subscribed before me of
✓ by ' al Presence or Online Notarization 15ical Prese ce or Online Notarization
this ay of 202Dby this 07�d�y of 202a'OZ, by
'� �l lam+
Name of person making statement. Name of person making s atem n
Personally Known OR Produced Identification °' Personally Known OR Produced Identification
Type of Identific_at<ioon y Type of Identification
Produced ll.•�l — J Pr d
Irm (A.7
(Si a ure of Notar P lic- (Si ature -
mission No. '' P`" JENNIFER DAVIS Rq'vb�yr JENNIFER DAVIS
*. COMMIS 9GG95U18 Commissio SIGN0GOW0
• o��.. EXPIRES:February 29,2024 *I, XPIRR®;Febwary 29,2024
f� ?d
d IM111 AOS&A I MINOU floral]
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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COMPLETED
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