HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number•. HECEIVED
Sir, w(9019-1-"L MAR 15 2022
St. Lucie County
BUilding Permit Application Permitting
Planning and Development -services
Building and Code Reguldoon Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (IM) 462-1553 Fax: (772) 462-1578 -CBDG Funding
PERMIT APPLICATION FOR:
5E
rG MEI 1, MT IN, 11�1
11, I'M
Address. neiA(L,,X C 4 d E/- 3cf 95r
Property Tax ID . 004-1 (In 0001, 0000 Lot No -
Site Plan Name- Block No.
Project Name:
----------------
New Electrical Meter Second Electrical Meter (Affidavit required)
a
,�, V-7
51
Additional work to be performed under this permit -check all that apply:
—Mechanical — Gas Piping —Shutters Windows/Doors Pond
Electric Plumbing — Sprinklers —Generator Roof Pitch
Total Sq. Ft of Construction: 120 Sq. Ft of First Floor:
Cost of Construction:$ 13100-02 Utilities: _Sewer —Septic Building Height:
IT
Name C (A gg, G g- De kb-:,- ;�i-
Address: 2-tQ15'0 N F- A<6% +cef
City: State:
Zip code: 3 Ll q I L- Fax: City: State;
Phone No. T 12 -- 3*10 - (a —E- Zip Code: 6-4,q-f &_Fax: 163 7s.3-534-1
Mail: C r -k c kstr )(- LOO &tc'GiC" C-21"" Phone No-1-12- 3'10- (9126 ---
Fill in fee simple Title Holder on next page (if different E-Mail 61'e. e- lCe-,- tRbj (AS
of •Cow
from the Owner listed above) State or County License
if value of construction is 2500 or more, a RECORDED Notice of commencement is required.
if value of HAVC is $7,W0 or more, a RECORDED Notice Of Commencement is required.
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DESIGNER/ENGINEER: _ /Not Applicable
MORTGAGE COMPANY: v Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: "ot Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zap: Phone:
OWNER/ CONTRACTOR AFFIDVff: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work orinstallation 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 apphcable 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 1 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 morns 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
Inrith IPnrinr nr an attnrnav hPfnre rnmmencina wnrk nr recordine vour Notice of Commencement.
Signature of Contract - or - Owner Buildtf as applicable
STATE OF FLORIDA
COUNTY OF �I— -• (ta c
m�
Sworn to (or affirmed) and suoscribed before me of Physical Presence or Online Notarization
Mar
thisl5tdayof .20,22-by G�lO�fl�s Sohn I�ek-��Sr
Name of person malting statement
Personally Known OR Produced Identification
TV:: I en • cation Produced � L_
(Signature of Notary Public- State Florida)
�a.dit
�of
Commission No. I ot%q / (Seal) 4�j<°•: TAWANDA PINKSTON•CASTRO
�1 Notary Public - State of Florida
p���a`O Commission : HH ' 27099
My Comm. Expires May 6. 2025
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