HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED u
Date: Permit Number: °L\�d' d1 5 1
1T.ILUCE .. O RECEIVED
=_ .,D.::: - Building Permit Application OCT 2 6 2021
Planning and Development Services St, Lucle County
Building and Code Regulation Division Commercial Residential permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:/D/D2 S DEcAAl ,>4 0, V/7-J37A .YZA/ScA1 8c�c� CC 3119- 7
Property Tax ID #: /7/S-02 - 6 D2 -- OO2 y - DOD - g Lot No.
Site Plan Name: SE617b- A✓ V1,e41 /6:C : D Zz3 7 Block No.
Project Name: TG/a .vTjS GONb 0 ?4b 6� A 41A/ / T 3074 — Jf 4 AAI_0 Y
�` "DET�;l�CED�¢DES�Rrl1'T!®I1l ®F�V,�a
y' t':•y.-
F,51-I D t/E P,44711 T/ o V 1AJ4 L /�✓ K i� �ia�.✓ .q�✓ d ,�c GocA � D �� �� F' J�/�>cy�.r.
P &I-19 i110!-L. ,eA rl-I f/aD AJ &_X 41VP /.✓JTA 11- /✓C!�/ f./N�.�. PAS✓ � ✓/,1 L f/E ILc T / LC
IlArgzz- 3D,4 G/11G�uiT F'Ry,., ti/iRc PGvJ �✓/�r�z '6✓,9.fTl- Gi,✓r'.s Fa.e JTiae��A6/�
New Electrical Meter Second Electrical Meter
y4llIYJ'IE �' M-. Nam' pO.I1,'.klVi�� 1,QNr
Additional work to be performed under this permit- check all that apply:
_Mechanical Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
IL-Ilectric V Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: A D Sy3 Sq. Ft of First Floor: /,
Cost of Construction: $ O L) Utilities: ✓ Sewer _Sepfic Building Height:
-
Address:/D/D2 S DEcAAl ,>4 0, V/7-J37A .YZA/ScA1 8c�c� CC 3119- 7
Property Tax ID #: /7/S-02 - 6 D2 -- OO2 y - DOD - g Lot No.
Site Plan Name: SE617b- A✓ V1,e41 /6:C : D Zz3 7 Block No.
Project Name: TG/a .vTjS GONb 0 ?4b 6� A 41A/ / T 3074 — Jf 4 AAI_0 Y
�` "DET�;l�CED�¢DES�Rrl1'T!®I1l ®F�V,�a
y' t':•y.-
F,51-I D t/E P,44711 T/ o V 1AJ4 L /�✓ K i� �ia�.✓ .q�✓ d ,�c GocA � D �� �� F' J�/�>cy�.r.
P &I-19 i110!-L. ,eA rl-I f/aD AJ &_X 41VP /.✓JTA 11- /✓C!�/ f./N�.�. PAS✓ � ✓/,1 L f/E ILc T / LC
IlArgzz- 3D,4 G/11G�uiT F'Ry,., ti/iRc PGvJ �✓/�r�z '6✓,9.fTl- Gi,✓r'.s Fa.e JTiae��A6/�
New Electrical Meter Second Electrical Meter
y4llIYJ'IE �' M-. Nam' pO.I1,'.klVi�� 1,QNr
Additional work to be performed under this permit- check all that apply:
_Mechanical Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
IL-Ilectric V Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: A D Sy3 Sq. Ft of First Floor: /,
Cost of Construction: $ O L) Utilities: ✓ Sewer _Sepfic Building Height:
-
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'
NameS41lIbS AKd-5_ oM /r✓✓Y-SiIV �4rS GZ 6
Name: ")W-elXID^J c0,'J7E 4 C>OjLS
Address: 9376 .sw 'IS-6 TH pL
Company: P'/2G L i t/o�/ ��✓T/Lg C, jZS lie
Address: /S_02 J J 64 A✓E
City: 1014NI1 State:F
Zip Code: 33 % C/ Fax:
City: PJ'L State: FL
Phone No. 786 - 223 _/9/
Zip Code: J g4?S3 Fax:
E-Mail:,,TG-SA -✓%OsdICX6/9/G- 60,w1
Phone No 77Z_ 9Zy- I-3G 6
Fill in fee simple Title Holder on next page (if different
E-Mail-rO/NcD �Pl �� rf�o�J cy,�9jrgG;v�� mac,
from the Owner listed above)
State or County License CGG / 52 7Zs-gs
it value of construction is Z5a0 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.
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S.UPS'jEM�l+�1TfkCONSTRICTI®,NL1El;sLlW`1NFORMA
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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:.S4AW X F&2�'D aM
Name:
Address: 937P Sw /,5"4. nY P4-
Address:
City: 1 7 i H 1, )rL-
City:
Zip: 33 i q6 'Phone: 781,�,
-22 3 - / 9/6-
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 is in 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 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
improv,em,ents to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie oun ty and ost � on the jobsite before the first inspection. If you intend to obtain financing, consult
with ender bran tt rn v hefore rnmmpncinurwnrk nr rprnrrlino vni rr Nntiro of r nmmnnromcant
GJ
f Owner/ It
see/Contractor as Agent for Owner
Sig at;0FFLORIQA
r
Signature of ontr License Holder
5
STATE OF FLORIDA
COUNTY OF /"); CM,i o
COUNTY OF 24r Lut%,isL
Sw rn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
k Physical Presence or Online Notarization
this day of rJCiejhC( 12020 by
thisQZ day of_ ,r� . 2020 by
�) U ar,. 3 U nco-
Name of person making statement.
Name of person making statement
Personally Known OR Produced Identification V
Personally Known OR Produced Identification
Type of Identificati
Type of Identific ion
Produced EL
Produce OC-_
�iyiv'a�e., ELIZABETH COLE
ip • n a Public - State of Flo
(Signature of Notary Public- State or'OF
i natu a of N tary Public- Stat a Commission q GG 94657
Notary Public State
Commission No. Leonardo
,oF�,.' y Comm. Expires Jan 12,
f F orida pptt,,rr,� " Bo d t oUgh National Notary.
n No. l'J�
Jesus Per
�• My Commission HH
Expires 03I31' 025
z�ommi
12281
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