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HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number. © xU
lz
CI ,
v RECEIVED
Building Permit Application
JAN 91 2022
Planning and Development Services
SSS..Lyycie Cou�nty
Building and Code Regulation Division Commercial Resider 'AcmeiNittg
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR:
D Ifs 0 I N
Address: '7y0,S_ S13 NTY-4 C 1613,(3 Q LU D
Property Tax ID It: _BD17 6d-7- ooL46- 006—L( Lot No. I. A _
Site Plan Name: Block No. 71 7—
Project Name:
% - ARK;
wo1 c 1 1. of loss
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vyl e ,o t 11 iv) n
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 _Plumbing _Sprinklers _Generator I/Roof (1/ Pitch
Total Sq. Ft of Construction: 2Jo .S ts?1-f Sq. Ft.of First Floor: t3 00
Cost of Construction: $ i-700 Utilities: _Sewer ptic Building Height: tl_1
IL
WARM
3'
Name i Qt use MCG1h+h l cy') Name:-<ncc c_ �-J kill e7
Address: -]4D S 50,64-�q d a vow Slua Company: O 4e C.k 12c'n 0 Pi Q L L�
City:-fM'f4�6'EC[� State: Address: I?,7_n 2_I.s� �V� SU�
Zip Code: Fax: City: U`eV© b*2Gl qState:
Phone No. ]M- S l GU7 E- Zip Code:_ 3��(G,2 Fax:
Mail: Phone No 172- W4 S -7/.sfo/.s
Fill in fee simple Title Holder on next page(if different E-Mail' O -e C k
from the Owner listed above) State or County License 00 �s.
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.
IT UWAFATirre
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.
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 au applicable Homeowners Association rules,bylaws or and covenants that may restrict or prohibit such
structure. Please consu t 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 Contra r-or-Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF , 1�
Sw to or affir d)an subscribed befor me of Physical Presence or Online Notarization
this 1 day of 20y
`e- 0
Name of person making statement. /
Personally Known OR Produc ntif'cation
Type of Identificati Prod ed L
(Signature of Notary ublic-State of Florida)
yP�,, KAREN S. NIELSEN
Commission No. Seal _ e State of Florida Notary Public
(Sea[) -. �_ Commission # GG 207484
01�,___
;� My commission Expires�°�` June 12, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW- REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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