HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO* MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number.
Building. Permit Application
FEB 0 8 2021
St. Lucie County
Permitting
Planning and Developmentsenrices
Building and Code Regulation Division Commerdial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (712) 462-1578
PERMIT APPLICATION FOR: �6 jr ydc J�
-PROPOSED"IMPROVEMENT LOCATION:
p
Address: 7.30 J n� he( Al e% o5Oe i,WA l
Property Tax ID•#. :114999 = /6 0 — 0 00 — Lot No. -50�0
Site Plan Name:SIC W4 Moe % 9 3M, ol,— Block No.
Project Name:
�DETAILE*DDESCR`IPTION',OF WORK:
.-IA J* v it / O_ - - A . -,& - - • Af- _ _ e D
r -
i .
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windowp/Doors _ Pond
_ Electric _ Plumbing _• Sprinklers _ Generator Roof Pitch.
Total-Sq. Ft of Construction: 4,d o Sq. Ft of Firstfloor: et 00.-I
Cost of Construction: $ /S;DoO. — Utilities: _Sewer _Septic Building Height:
0WNER/LESSEE:
CONTRACTOR!,
Name
Name:
Address: 9
Company:
City: -State:
Address: 94 ao
Zip code• _35/947 Fax:
City: ;st State:
Phone No. ,.7 7aj 9 7 9 - s//93
Zip Code: &�%4 Fax:
E-Mail: •
Phone No ( A) b.?W-A:S'7
Fill in fee simple Title Holder on next page ( if different
E-Mallh 6 s t (F Ralf 4- .z ► Cori
from the Owner listed above)
State or County License
■ .o■..� �■ w■.au u�«��� �� caw or mure, a•rcccuxuw imotice or 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�ENGINEE
Name:
, NotAppficable
MORTGAGE: COMPANY: Not Applicable
Address: /
• E.
Name:
City:
9 !0f
Address:
Zip- Phone Q y/.�9
Stater
-
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
Name:
Not Applicable
13=ING COMPANY: Not Applicable
Address:
Name:
City.
Address:
Zip; Phone'
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 cepresentation that is granting a permit will authorize the permit holder to build the subject structure
which is in con"flirt with anx applicable Nome Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association'andreview 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 SL Lucie County Amendments.
The fo(lawing 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 job -site before the first inspection. If you intend to obtain financing, consult
with iender or an attOr before commencing work or recording Vour Notice of Commpnr_iarnant
I
Signature
Signature of
STATE OF FLORID, J W. STATE OF FLQRiD 1
COUNTY U C�c�2 COUNTY OF ��
Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
.�Fftysical Presen a or Online Notarization
this Physical Presence or e Notarization
day of 20 -0— by this I day of Online
202Z by
Name of p son maMgstatement Name of person makk4Atement.
Personally Known- t�O_OR Produced identification
Type of Identification
Produced
�^ �.ls* �4` Notary Public Sgte
commission NO G �`fBunnie Merritt Wog
i� My Commission HH
pia �dO' Expires 0916712024
Personally Known - /c:2r OR Produced Identification
Type of Identification
PPrroduced.
of Notary
IM
=Qebl c State of Florida
Merntt Woodard
My Commission HH 039826
Expires 09/0712024
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