HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12- /�- �✓'L Permit Number:
T- 0P
� f RECEIVED
FEB 1 2021
Building Permit Application St.Lucie County
Permitting
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pierce Ft 34982
Phone:(772)462-1553 Fax:(772)462-1578 CI3D0 Funding
PERMIT APPLICATION FOR:
;.PROPOSED 1 PROVEM ENT,LOCATION .
Address: .5 r Tan ®vim vc � e-M
Property Tax ID#: �'C� ^ 0 9 �" ' � Lot No.
Site Plan Name: Block No, �S
Project Name:
DETAILED DES'CR'IPTION OF WORK; :r
ziell
V_d
)e - GCE -
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 _T..Sprinklers Generator Roof Pitch
Total Sq. Ft of Construction Sq. Ft,of First Floor:
Cost of Construction:$ b d o ' Utilities: Sewer _Septic Building Height:
OWNER/LESSEE CONTRACTOR:
Name Le,c :,e f2 Name: i '
Address: .S"/ )vt h I2� Company: O^
City:_-?`a^c'�' %��e�r�C. State: Address,• 6l0;7- Al na 0;/-
Zip Code: 321 7�F2- Fax: City: For+ jOi',et e_- st te: FBI
Phone No `]7 2- Y $ to E- Zip Code:,. i Fax: ? � 2 ' _3"7
Mail: Phone No 7�? y . --
Fill in fee simple Title Holder on next page(if different E-Mail kole �' r:> ,c
from the Owner listed above) State or County License nn .. l
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,
;SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: - State: City: - Sta e:
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 prohi it such
structure.Please consult with your Homeowners Association and review your deed for any restrictions which may appl .
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-residentia 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 rTcords of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain finan ing,consult
with lender or an attorneybefore commencingwork or recordingour Notice of Commencem_nt.
i
Signature of Contractor-or-Owner Builder as applicable
STATE OF FLORIDA (�
COUNTY OF -�J
Sworn to(or affirme nd subscribed before me of _ Physical Presence or Online Notarization
this�day of _(Z, 2 aby
hil i("kict -,a TrAr�.
Name o person making statement.
Personally Known OR Pro Identif anon
Type of Id tification Produced
(Signature of Notary Pu li -State of Florida)
SP{IY PU6' .� AUDREY B.HMIpHP,EY
Commission No. (Seal) __° �°= MY COMMISSION# GG 30021 4
=Nr• e 4 z= EX'IRES:vi8rCi1.i,20,
°c= Gonded Thtu Nrtay Pubac iJ idenvr t r 3
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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