HomeMy WebLinkAboutBuilding Permit Applicationf:. _ 4
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3. Ire- 10Z2, Permit Number:
RECEIVED
WOE
o F - MAR 16 2022
p L� _ 0 Building Permit Application St. ucieCount
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: 114-\ ;G
PROPOSED IMPROVEMENT LOCATION:
Address:-7S1 SC Sy L'Pt-t A -us -A)938e'r LuLI C 3 V I VS
Property Tax ID #: A\`�- SIAS-ao53-Od0 -S Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK � .
New Electrical Meter Second Electrical Meter (Affidavit required)
i
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: $ _ �i�®� Utilities: —Sewer _ Septic Building Height:
OV11Nf R/LESSEE:- "' .
CONTRACTOR
NameILI b
Name.
_
Addre�s7s�:451 SC Svc p-:iL _
Company:
City: S'r Lux'l E State:
Address: 74sc' SO R(45rA 1`W,_k7E 2 iQCtJt
Zip Code: Fax:
City: Poy*- ST L-LIL4 E I State: �1..
Phone No.YS G - S 2 "%S E-
Zip Code M 23 ' Fax:
Mail:
Phone No� Z • S Z�';S y
Fill in fee simple Title Holder on next page (if different
E-Mail
from the Owner listed above)
State County License 67L/ 30)04) q
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
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:
City:
Zip: Phone:
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,whlch 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 playing 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 attomev before commencing work or recording; vour Notice of Commencement.
Signature of Contractor'- dr:_6w—her Builder as applicable
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this \S day of 1v1 i , 20a� by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced —
(Signature of Nota ublic- State of Florida)
Commission No. . ' (yAGIVENs
Notary Public - state of ;iorida
"o Commission # HH 086359
My Comm. Expires Jan 28, 2025
ofF,o
Bonded through National Notary Assn.
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