HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INF9,DMST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
_10_651^ Da 10
Date: Permit Number: 8;:rEIVED
FEB 0 2 202Z.
Ov. LUCE-
�1 t St.,county ;Izt I � *1'
PpEr"'u'o I ffil*:2�1,� W?,Iwe Building Permit Application PermLucie itting
Planning and Development Services
Building and Cade Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Cl3DG Funding
I
PERMIT APPLICATION FOR: fqe
RoO�
"6
Address: 2i Shefulcoi LN j=i-Pierce r-Y. 3q9k_a
Property Tax ID #: t— 701 - opt (10 cm- (10
Site Plan Name:
Project Name: ""I LCu J 13adw-0.
New Electrical Meter
Second Electrical Meter.
(Affidavit required)
Lot No.
Block No.
A 0, N ST XJNFO
C RU
71
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 &--Roof Pitch +'12—
Total Sq. Ft of Construction: 3100 * Sq. Ft. of First Floor:
Cost of Construction: $ /0 A OX Utilities: — Sewer — Septic Building Height: 20
�
OWN
Namebatz A&ewdad
Name:
Address:gqX Shffu= d W
Company:
City: F 7t - A Lyc—e State:
Address:
Zip Code: 3Wk2— Fax:
City:
State:
Phone No..71V 4�6 NOR
E-
Zip Code:
Fax:
Mail:
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 required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not App icable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: tate: City: Z State:
Zip: Phone Zip: Ph e:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: _
Address:
City:
Zip:
Phone:
Name: C
Address:
Citv:
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
%.,itk IcnrlAr nr nn nttnrnpv hpfnrp rnmmpnrine work or recordine vour Notice of Commencement.
cSig_nature_of Contractor - or - Owner Builder as applicable
STATE OF FLOR�A��
COUNTY OF
Swor to,r affirmed) and subscribed before me of ✓ Physical Presence or Online Notarization
this *y of / 20 by
�a ll�ra Pl QS21'l 1Cv
Name of person making statement.
Personally Known ✓ OR"Produced Identification
Type of Identification Produced
QQ bxluz a
(Signature of Notary Public- tate of FI ri a)
1Q! �t P°B CELERINA ALVAREZ
No. /o��Seal)�°'� ~' V
Commission Commission 9 GG 978235
'I `oQ Expires August 14, 2024
oF�t°BWedilwuS4'etNoterySwws
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Rev 10/12/21