HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �� ,A
Date: Permit Number:a LJ I U
RECEIVED
o� MAR 0 4 2022
Building Permit Application St, Lucie Cou
Planning and Development Services Permittin
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:
PROPOSED�,IMPROVEMENT LOCATION!
Address: 2 J 1(9 t6 A Wg h GGtrgl'
Property Tax ID #: 31 9D - 1 o J' 0 d 3 5 O G Q v 1 Lot No. 3-9
Site Plan Name: o Block No.
Project Name: A ffln �NSI�enC� enet'GS6EL
DETAILED DESCRIPTION OF.WORK: `,
inS611 9CUAKV PU6VAF-JK,TCGJ\SR,- 5VJ'% , ZL I ssK�s
��er�sv+G} I� ► N 5� l� �� �,�ater� ��,
New Electrical Meter Second Electrical Meter
CONSTRUCTION INF.O;RMAT,IO_N
(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 — Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 1.906. tic) Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:.
CONTRACTOR:,,.
Name o�,,,Z ,
Address: 9116 ICIQWah LAW,
City: 962tS Ujcle State: FL
Zip Code: 34190 Fax: A
Phone No. -7A- 1 2,131 E-
Name: eandA �CMVin
Company: Paz\ wuir\ e�lecl LCc
Address: 500C IN Olio` R&
City: FG2t Plez cE State: �L
Zip Code: 34161 Fax: N tFt
Mail: Ck 1>16'1>0Me (arA-e G Cngl 1(gVY\
Fill in fee simple Title Holder on dext page (if different
Phone No `71e),`370` !?
E-Mail f obi herftvn C Ie-WC- l carlcctst one t
State or County License E 07 1306 (091IS 3
from the Owner listed above)
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: _
Address:
City: _
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citv:
Zip: Phone: _
State:
Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 attornev before commencing work or recording your Notice of Commencement.
Si a for - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF Lx. 1 uk!l if
Sworn (or affirmed) ands bscribed before me of Physical Presence or Online Notarization
this day of Y 2Q223y
DKJI14 ( -'b b[ajc,'>#"-aZ
Name of person making statement. /
✓/
Personally Known OR Produce a tification
Type of Identific ion Produced
A 1,0L
(Signatur of Notary Public- State of Florida)
Commission No. (Seal) 1YP 8 o KAREN S. NIELSEN
PR 4��
� State of Florida -Notary Public
=� •= Commission # GG 207484
My Commission Expires
June 12, 2022
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Rev 10/12/21