HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
a��o3�3
RECEIVED
Lam' y DEC 13 2021
Building Permit Application St. Lucie County
Permitting
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1.578
Commercial Residential
C13DG3 Funding
PERMIT APPLICATION FOR: e7,7
pROPOSD IMPR(�1/MENT I:OCATION 4 Y.
Address: 74-f �3 b S U S / APA'Z '" y
Property Tax lD#:-3(-'/ ZZ /3 Y004 L_�O_ z01 Lot No.
Site Plan Narne: ti 4' Block No.
Project Name: Ze-(%O S (J /fe— y /
13�5 A,' UGC SIJ�• 7-z:;) foorol,'7Z= 7'V6
New Electrical Meter Second Electrical Meter (Affidavit required)
Additional work to be performed under this permit— check all that apply:
_Mechanical _Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
✓Electric i,' lumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: 'Z 5W 51 Sq. Ft. of First Floor: 2 3-',9 C)
Cost of Construction: $ / Z Ooo = Utilities: —Sewer —Septic Building Height: /O �T
011U(vEf/LESSEE;' _'
C(7NTRACTf?R `'
Name 'T T
Address: 30 sT /� �/l
LG
i :. jsZ';�%�' "`
'Company:
City: /1/ G'w �os2/G
Zip Code: /J� O/ fo Fax:
Phone No.
Sfa"te
E-
;:Address:.=-'3�6
State:
Zip Code: G/ ? g 3 Fax:
Phone No -772- 7- Ll f//,0
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail /S Z)
State or County License C 0-G / S-19 � Y
If value of construction is 2500 or more, a RECORDED Notice of Commencement is requires.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
Name: _
Address:
City: _
Zip:
NGINEER: _ Not Applicable
State:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
_ Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name: _
Address:
City: _
Zip:
Phone:
Not Applicable
State:
Not Applicable
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
wi"nder or an attorney before commencing work or recording your Notice of Commencement.
nature of Contractor - or - Owner Builder as applicable
STATE OF FLORID r
6--otc-
COUNTY OF I ,
Sworn to (or affir ed) and subscribed be ore me of K—Physical Presence or Online Notarization
this ( day of ec 20 by
f—C-9
` 9 F, C U
Name of person making statement.
Personally Known OR Produ Identif' ion
Type of Identifi i .1Pro uced� /
(SS g afire ot�a/r%y Pu lic-�St%aatte of Florida)
commission No. IT 1 � 1'll (Seal) o��������. JOSEPH GOMEZ
��
�w PV
Ba�,Notary Public -State of Florida
V6
®, Commission f♦ HH 180416
"w�o M commission Expires
November 16, 2025
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev 10712721