HomeMy WebLinkAboutBuiding Permit ApplicationAll APPLICAPLE INfOMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: 002a Permit Number: aOL�a"d 13 0�
RECEIVED
FEB 16 2022
P LL Building Permit Application St.,LucieCounty
Planning and Development Services Permitting
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:
RROPOSED,IMPROVEMENT LOCAT10N:
Address: (0156 < CIC Icl- I�Ay b
Property Tax ID #: 1301 - CO 3 (9a - n6o ^ I Lot No. ' lV
Site Plan Name: Block No.
Project Name: B600 -G Qe. V4)C.)f
DETAILED 6ESCR;IPTI�O�N� OF WORK:
_
e. (� laces W 1 l-es
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P(. �` b "
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTIONINFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric _ Plumbinrg� _ Sprinklers _ Generator Roof C5 = (a Pitch
Total Sq. Ft of Construction: 0�, U Sq. Ft. of First Floor: o� 0, 5 (.0
Cost of Construction: $ I S , OL 60 Utilities: —Sewer _Septic Building Height:
OWNER/LESS'EE:
CONTRACTOR:
Name k1pne V'ronwb
Name: lt1
AddreI SCOCN*-c- Cara- r1 IVb
Company:—(vL CB(t1 SE(VLCeS raC.
City: Gaa'pl'er.e-- State: PL
Address: 3qg I SU) PALCe SNA-
City:?LC}- SCctr* -LCL-f— State: ��-
Zip Code: 3(40t ( Fax:
Phone No. E-
Zip Code: ?V QQ 5 3 Fax:
Mail:
Phone No LD 31- - 4 -10
\Fill in fee simple Title Holder on next page (if different
E-Mail SLLA.66LrnSe(V t t-e S
prom the Owner listed above)
State or County License C�C.L� 315`3
flue of construction is 2500 or more, a RECORDED Notice of Commencement is required.
1 `ue 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:
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:
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 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,attorney before commencing work or recording our Notice of Commencement.
Signature of Contractor - or - Owner ilder as applicable
STATE OF FLORIDA '
COUNTY OF
Sworn to (or affir ) and subscribed befI2re me of
Physical Presence or Online Notarization
th"is49— day of 2&Vby
1�Ir 2 A
Name of person making statement.
Personally Known OR ced Id ntifica io_n
Type of Identification Produced --
JALM
(SignaturVof Notary Pu ic- State of Florida) —� 1
AiJDREy B. HUMPHREY
Commission No. (Seal) MY COMMISSION # GG 300817
6, ?_02-
1
r.XPIRES: ^aarch
Bonded Thra Nntary Putriic Und rtmterc
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5tzLm%9�E -__
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DATE
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DATE
COMPLETED
,11 Rev 10/12/21