HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ® o
Date: 11 0 61.22 Permit Number: ��r y
RECEIVED
L ° Building Permit Application JAN 2 6 2021
St.Lucie County
Planningand Development Services
p Permitting
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: CaraCA&
PROPOSED IMPROVEMENT LOCATION:
Address: 551. ( C-r'eew botokh'i Ff Pierce- 3`f45(
Property Tax ID#: 1 '?01- COX- 10 WS--600-3 Lot No. 25"
Site Plan Name: Block No. 16
Project Name:
DETAILED DESCRIPTION OF WORK:
&P Luce l 6 X 7 (->r mg e Joo r cj E+k e, t4aa.s Gc cr ge d do r N G Y 7 )
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 "indows/Doors _Pond
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ /ue),60 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name ',Torc)h+ 9d-d LdrJ Name: T5S AC Rorie
Address: 5.5/1 - 6r'eeiU bo ll0t0f Company: A�TdCh Q-ai-cj t66r_;
City: r-� Pi'eriz State: rC- Address:_yg(;q- AJU-) /uorkk m4 ed6 eiud
Zip Code: Fax: City: po4 5CiA14 Lclrio" State:
fL-
PhoneNo. 772- 27-5- 56fsb E- Zip Code:_3 ` qq3 Fax:
Mail: Phone No -77d-87-8 5gZI
Fill in fee simple Title Holder on next page (if different E-Mail A'feciH aiarA4, 4►Y14.(c ;&aftt from the Owner listed above) State or County License 2 f1368
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ 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 lender or an attorney before commencing work or recording our Notice of Commencement.
Signature of Contractor-or-Owner Builder as applicable
STATE OF FLORID�� LyL��C
COUNTY OF
Sworn to(or affirmed) and subscribed before me of —(Z'<hysical Presence or Online Notarization
this ui day of ZAy%.1 .20 Z'4y
Name of person making statement.
Personally Known OR Produced Ide t�ification
Type of Identification Produced
(Signature of Notary Pub' -State of Florida)
Commission No. (Seal) �;,,aYP�a% HEATHER BURFORD
psstate of Florida-Notary Public
=* *= Commission # GG 183217
My Commission Expires
i�OF FV°PO•
" February 06, 2022
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