HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3.7• Zip, Permit Number: 07D
RECEIVED
` MAR 0 7 2022
- -r - Building Permit Application St. Lucie County
Planning and Development Services Per ng
Building and Code Regulation Division Commercial Residential 7
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMP OUEMENT LOCA ION:
Address:
Property
Site Plan Name:
Project Name:
(-lepige-e t40 Crcman F_Je4f iC wct�er
Block No.
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTR CTION INFOR+MATION:
Additional work to be performed under this permit!--- check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters —Windows/Doors _ Pond
_ Electric Vumbing _ Sprinklers —Generator - _ Roof Pitch
Total.Sq. Ft of Construction:
Cost of Construction: $ % Act S. �o
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LE=US�SEE:
CONTRACTOR:
Name Lev.,ea
Name:
Address: 1901 !V WCgtoWqu A 1R
-_
City: af-4- Piers-C � J state:�L
Zip Code: Fax:
Phone No. E-
Company: 0jofllool%pr
Address: {QOl Crre"n
n I -100.,
City: Ni-i in"o State:
Zip Code: 7`1i0�'D� Fax:
Phone No
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail S9f1-oAeY1Q Y,,,Y,4 S ® i- rsc -
State or County License GFe I k_J26dOQ1
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
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: _
Address:
City:
Zip:
Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
_ Not Applicable
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.
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of , 20_ by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- State of Florida)
Commission No. (Seal)'+;
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Rev 10/12/21
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
BONDING COMPANY: Not Applicable
Name:
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 jdbsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording your Notice of Commencement.
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORID 11
COUNTY OF'('OWe►T-6`
Sworn to (or affir ed) and subscribed befoxe me of Physical Presence or Online Notarization
ckrc_V\
thisn day of , 202G by
Y1"n1 -,
-'Name of person making statem
Personally Known OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- State of Florida) lisp ,�
PL%, SYMONENA NICOLE Simms
� ,�<
14 �- Notary Public -State of Florida
Commission No. (Seal) Ommission # HH 220898
"l"t y Commission Explres
January 25, 202a
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 10/12/21