HomeMy WebLinkAboutBUILDING PERMIT APPLICATION 1-11-22 All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /o1-20 2DPIVIs® Permit Number: .
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tfilfdtfig Permit Application
Planning and Development Services
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: ,�pa�(AG
PROPOSED IMPROVEMENT LOCATION;
Address: -/'90y/ 1t4 rf4Xdk L-446�J A6 0e_
Property Tax ID#: 3JU,�6 I - O y G Z `00o '' Lot No. Z.
Site Plan Name: 12&i F2✓c ��Sn�o J-ti, , Block No.
Project Name: t FA.1,FG.L. 4ce'E✓1
DETAILED DESCRIPTION OF WORK:
re^--e r._wwD sl.9k� . ,.�,I-41" iQ/2 eDX e&we
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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 _Windows/Doors _Pond
_Electric _Plumbing _Sprinklers _Generator _[Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor: , -3-/V/
Cost of Construction:$ �'D g O . Utilities: —Sewer —Septic Buildin Height:
OWNERAESSEE CONTRACTOR:
Name dc1?n IFd¢ r nOAC c_ &C.1 Name: z'r_ 4 7,0&z
Address: 79oy A/417-4-�a+•� Lv- f �•crU2 Company: W C1 �✓� -y e
City: 17nn",e_f1- 4wa;1 State: r--(- Address: 1S'J-1 eI6 CgzD�'��� •�"'e
Zip Code: Jy5c:V/G Fax: City: State: ��-
Phone No. 5Zv(- 7l y- -1 1/0 E- Zip Code: 3!V Jc' 9 Fax: 772 2S Z `Fe7 Z
Mail: kC1.7inn,^-O� G 9^".4��• low` Phone No 77Z -23 L -Yk1 z-
Fill in fee simple Title Holder on next page(if different E-Mail roy &Ke,,xkez Q /,'ve
from the Owner listed above) State or County ty License eGC OY7L rr- rSo&i (,
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.
i
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION",:.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name: —2ee.. -
Address: Address A Q,J1oK 61?,097
City: State: City: D4&4 State:?_X
Zip: Phone Zip: 73-
2-1 / Phone:
FEE SIMPLE TITLEHOLDER: _Not Applicable BONDING COMPANY: X 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 lender or an attorne efc a commencing work or recording our Notice of Commencement.
Signatur o caner/Lesse ont actor as Agent for Owner
STATE OF FLORIDA
COUNTY OF FAA9T4
Sworn,to(or affirmed)and subscribed before me of Physical Presence or Online Notarization
this M day of IJ6d9PA%V-X 20?�. by
t2dY a�ERnla�sDEZ-
Name of person making statement.
Personally Known�_OR Produced Identification
Type of Identi ica ' n Produce
(Signature of Notary Public-State oN4QrLidad
Commission No. (Seal) E
P�Q Notary Public State of Florida
Richard P BrockwayMy Commission GG 221619 Frtd Expires 05/23/2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev5/20/21