HomeMy WebLinkAboutBuilding Permit Applicationti
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �. 1i
Permit Number: aA \a'G bk
RECEIVED
DEC 1 2021
Building Permit Application€2P@�m�ln
`
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
PERMITrAPP(LICATION FOR:
PROPOSED IMWPROVEMENl' LOCATION
,'. �J `� tiV I.�r': +<s�`w.f
Address: '.LT A 8e (Vr-
Property Tax ID #:q
c
`�" Lot No.
n�Ot
Site Plan Name: L�1® "" W l d
Project Name: �-
J Y'� (.,A q-�< Block No.
DETAILED DCR+IPTION OF
New Electrical Meter Second
Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:ila
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:
Cost of Construction: $ &9`1 01DJO
Utilities: —Sewer _Septic Building Height:
OWNER/L@159 :
CONTRACTOR.
Name:AAHK /•! one.
Name !,U ( Wi`i'1F 14We ~
Company: SiS
Address: 91 �'�o i P.i'1'� P1Y\e'
C
City: `-- PI100
State: -
Address: 60bJ5 qt"L sf
Zip Code: 3 1 Fax:
City: !6ezX I^ State:�-
Phone No.
E-
rL
Zip Code: `tc Fax:
Mail:
Phone. No
Fill in fee simple Title Holder on next
page (if different
E-Mail 19P,�S iSPoo QS 7 Aid GQY^
from the Owner listed above)
State or County License MK (4,546 a
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. -
SU4PPLEMENTAL COINSI'RUCTUON LIEN LAW
IN'FORMATI`O'N: -
DESIGNERIENGINEER:
Name: , C'ikC)t�cA�c{leeC\'n`l
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: N1"i"!tl(Ar'-± CZ--
State: Fc—
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
withlender or an attornev byre commencine work or recordine vour Notice of Commencement.
Aa '4-0
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTYOF il'1Gkon 9-Wey,
Sworn to (or affirmed) and subscribed before me of Physical Presence or -Online Notarization
this 2TA4day of OCA-UVae)(' 2021 by
-
Name of person making -statement.
Personally Known OR Produced Identification
Type of Identification Produced VL- OL
0 k,w p . ttrw-e-u
(Signature of Notary Public- STate of Florida)
Commission No. G62g1`2J9 Seal)
?�""°� CHRISTINA S. HOWELL
MY COMMISSION # GG297262
OF RAP EXPIRES: January 31, 2023
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Rev 5/20/21 - - -