HomeMy WebLinkAboutBuilding Permit Application ( Replaster )All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ^ �_ 0 ��
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Date: Permit Number:
RECEIVED
oo WOFEB 17 2022
9 :° - Building Permit Application St'pe°m; It County
Planning and Development Services
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: 5 P3.-u1s# f-ks -OGZ/ 1
PROPOSED IMPROVEMENT LOCATION:^�
Address: 1 S V f I zf m //U 6 i (J
Property Tax ID #: 36��_'/ Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
Le -
nu o�'J 5-ff"J ILL Le g Nejui
If B InAIA2 GDZA.A) 4361-R5
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
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: $ Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: 3r,,,q r/ Gcezre -
Address: o
Company: g42R�t7,_ez°i A& t- S'c .2 Vi,cQ
City: Gxs 7'.L -'G ° 2 State: d
Address: �kS`S�eJSNl,ya�
Zip Code: 3 �ZS� Fax:
��i.l�S
City: / t1Qzfcve- State:
Phone No. E-
Zip Cod e:.j//96"_3 Fax:%77_ -YYa—g9ci/
Mail:
Phone No 77 Z -.332-- S7 ZS`
Fill in fee simple Title Holder on next page (if different
E-Mail
w C�
State or County License
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
Name:
Address:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
BONDING COMPANY: Not Applicable
Name:
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
wil1k lender or an at"rney before commencing work or recording your Notice of Commencement.
iig—nature of Contra for - or - Owner Builder as applicable
STATE OF FLORID
COUNTY OF
an s
Sworn_Jo (or affir ubscribed befoAe me
of Physical Presence or Online Notarization
this day of y
(2
1A � 4-- l 4 �A`--
Name of person making statement.
Personally Know OR Produced Ide tification
Type of Identi ' ation Produced L
(Signature of Notary Public- State of Florida)
afar v�ai KAREN S. NIELSEN
;State of Florida Notary Public
Commission No. (Seal)
'= Commission # GG 207484
My Commission Expires
June 12, 2022
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Rev 10/12/21