HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BV. ,t)APLETED FOR APPLICATION TO BE ACCEL- _D
Date: i 1 1 S 1 E, Permit Number:
L UT Cl I
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2i.4,, 6 3f_1
RECEIVED
SEP 16 2021
Building Permit Application St. Lucie county
P
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial
CBDG Funding
PERMIT APPLICATION FOR: Mt* CkJJ 5 Ul J a it �
erMung
Residential V
PROPOSED IMPROVEMENT LOCATION: �7
Address: I C�
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
26x 1 mttw ow'I'din v -V_'21 I M
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
_ Electric _ Plumbing _ Sprinklers _ Generator
Windows/Doors _ Pond
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ � 03 Utilities: _ Sewer _ Septic
Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Z e r� S �, Ck V
Name:
Address: % oA ci C. kk l d k X' j Q l A CR
City: � S L. State: � L
Company:
Address:
Zip Code: "� Lk A Fax:
Phone No. �� `i..�� Lk 5E-
City: State:
Zip Code: Fax:
Mail: \A t\ , 5 �Wn4Q, ,cV
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail
State or County License
from the Owner listed above)
IT value or construction is Zbuu or more, a RELURUED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
di Y 11 1 .i�� Fh
PLEMENTALCONSTRUCTI0N.LIEN
LAW�JNfORMATIO: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 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 Ipndpr or an attornev before commencine work or recording vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF 54--
Swor to (or affirmed) and subscribed befoje me of Physical Presence or Online Notarization
this day of 20& by
Name of person making statement.
Personally Known OR Produced I tification
Type of Identification Produced
(Signature of Notary Public- to of Florida)
1ppYPLi, HEATHER BURFORD
State of Florida -Notary Public
Commission No. (Seal) _� Q= Commission # GG 183217
My Commission
Expires
February 06, 2022
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Rev 5/20/21