HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:. ! W' 01o)
RECEIVED
Date:
ST. LuCi
Rt0—A'
-
Building Permit Application
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:
PROPOSED hMPROVEMEI*T LOCATION:
Address: g21i
Residential
FEB 0 4 2022
St. Lucie County
XPermitting
.Property Tax ID#: (t('0 ' T 10J' 01 acl - 000 'S' Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED D'ESCRIPTION1OF WORK:
a*- ( ki✓ r o- � ,.t►/1 o S!a 6 U:fL l 2" X l 8 4
woo Ds: f':4-! M.c.s� C��-4l-�`�—L- 2� _Svd�-�� (b•fio�... A,._�1
New Electrical Meter
Second Electrical Meter
CONSTRUCTION INFORMATION•
(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
Total Sq. Ft of Construction: 28q
c
Generator Roof Pitch
Sq. Ft. of First Floor:
Cost of Construction: $ BOO , m 0 Utilities: —Sewer —Septic Building Height:
`OWNER/LESSEE: :.
CONTRACTOR`,"
Name c_�r_L' Zt'
Name: •
Address: ZZI?
Company: -Zr L Ce ^Gam -
I�� S L L c
City: /"/ .q t v -e L+ t__ State: FL
Address: ?-'60
C&..� 9 1
Zip Code: 32 17 S'Fax:
City: Arr
State: rL-
Phone No. SG ! -- 3 - 71 L H E-
Zip Code: 317 F 7 Fax:
Mail: �/"1 Z G r e-, Co Y--
Phone No 777 . 2l (o 13'1
Fill in fee simple Title Holder on next page (if different
E-Mail 1TC_ . Co., t4-e -f- � �%►
S i� �.d 1. ��
from the Owner listed above)
State or County License 2� 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.
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
is in
which conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners 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 Code's 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
rty. A Notice of Commencement must be recorded in the public records of St.
improvements t ou�edon
Lucie County a p he jobsite before the first inspection. If you intend to obtain financing, consult
with lender ttofore commencing work or recording our Notice of Commencement.
I .
Owner/ Lessee/Contractor as Agent for Owne
Signat;OF
STAT FLORIDA
COUNTY OF_�_
Sworn to (or affirmed) and subscribed before me of ysical Presence or Online Notarization
this day of 20.34 by
Name of person maki:�Mucecl
Personally Known Identification
Type of Identification Produced
(Si a ure of Notary Public- State Florida )
Commission No. (Seal) HEATHER BURFORD
of Florida -Notary Public
WState
. Commission # GG 183217
,��?.' My Commission Expires
nm
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