HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICA LE INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� �oZ Permit Number: C�IIJ�" ��0
RECEIVED
O 1
2a. Building Permit Application FEB 2 4 2021
Planning and Development Services St. Luci my
Building and Code Regulation Division Commercial ResidentialPerm
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION':F
g
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:_y U q
Cost of Construction: $ e5co Utilities: _ Sewer _ Septic Building Height: J-5 1 +'
OWNER%LESSEE a :
CONl RACTOR:
Name La wne w-c-e. Siir t-z
Name �0(1LLt� I �r1
Address: FtK61 TTG50 QO Iokea B IVd
Company:'-ag icUtn SPr y tc.c S ri\j c
Address: 34 4s I sLJ AA Lcc Sf-
City: it. l 1 erc-e State: FL
Zip Code: 34Q51 Fax:
City:_R0 rf- Satnl- Uv ct State: PL
Phone No. 5 lei -(P5 k 7 E-
Zip Code: 3t-1 Q 53 Fax:
Mail:
Fill in fee simple Title Holder on next page (if different
Phone No 2- LO3 l -1 O
E-Mad-BL CUI rse (-U t-4 e)' ccr�
State or County License e cc ►3315 '7 3
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 CONSTRUCTIONI N, LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Appli a
MORTGAGE COMPANY: Not icable
Name:
_
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone,-'
Zip: Phowl
FEE SIMPLE TITLE LDER: _ Not Applicable
BONDING CO ANY: Not Applicable
Name:
Name:
Address:
Addres
City
City:
Zip.Phone:
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.
ligature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA q
COUNTY OF
Swo t (or affirmedLand subscribed before me of Physical Presence or Online Notarization
t is day of 2Q y
GUDbI
Name of person making statement.
Personally Known OR Produc : ntif' t''S
Type of [dent' 'cation Produ d C�
(Signature of Notary Public- State of Florida)
NIELSP
N S. blic
Commission No. (Seal) lorida Notary
# GG 207484
sion
mmission Expiresune
Ego
12, 2022
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 10/12/21