HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -a Z Z. Permit Number:
96;? 112-� -0-VL1
RECEIVED
4V
FEB 0 2 2022
Building Permit Application st.Lucie County
Planning and Development Services
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:
PROPOSED IMPROVEMENT LOCATION:
Address: % I -1 S
Property Tax ID#: S ���� Lot No.
Site Plan Name: Block No.
Project Name:
DfTAILED..DESCRIPTI.ON:;Of WORK
'rcT/U 4A Z C, S�Pv1A �'Lce vt
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a) X4- L 4k LJ
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that apply:
Aechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Pond
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ 3 1 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE.., . <: .'CONTRACTO
Name y0 VI(Lb e V t°> Arn la AG Name: Y`- l -
Address: 9 L ] Q r/ a 1-- 1 i7 Company:
City: ?_Cnd -s k . LX C._p ( State:_ Address: t-Q 8 5
Zip Code: 3L4% Fax: City: — State:
Phone No. -7'77_ALA D /bO O E- Zip Code: &L4. Fax:
Mail: Phone No C) 0 Z
Fill in fee simple Title Holder on next page(if different E-Mail ko 0 ,
from the Owner listed above) State or County License G' �e-_ 121 7 6
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.
'SUR'PLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
DESIGNER ENGINEER: Not Applicable/ pp MORTGAGE COMPANY: JZNot 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 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
wilkiencler or an attorney before commencing work or recording our Notice of Commencement.
Signature of Contractor-or-Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF
Sworn to(or affirme and subscribed before me of Physical Presence or Online Notarization
this day of 20,22 by
n
Name of person making statement. /
Personally Known OR c Iden 'ficatio "
Type of Identification Produced , '
112j,d nghIrS. t��
(SignaVire of Not Pu lic-State of Flori a)
1
- AUDREY B.HUMPHREY
Commission No. (Seal) °P PdYCO1N�IIISSION4 0300817
EXPIRES:March 6,2023 !
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