HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ;go,3
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Date: Permit Number:
RECEIVED
A(COD)
LUCE MAR 15 2022
V ° :-IJURFL7 ° 1 ' Building Permit Application St. Lucie County
Permitting
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Commercial Residential
CBDG Funding
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #: L SP V 1 0 D 1 S 0 6 D / Lot No.
Site Plan Name: C6-00-gK Block No.
Project Name: Cro,�er�
DETAILED DESCRIPTION OF WORK: I
New Electrical Meter Second Electrical Meter.
CONSTRUCTION INFORMATION:
(Affidavit required)
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _Sprinklers _Generator
Total Sq. Ft of Construction: I?GD
64
Cost of Construction: $ /0.1 1457•
Sq. Ft. of First Floor:
Utilities: —Sewer _ Septic
_ Pond
Pitch
Building Height: /C)
OWNER/LESSEE:
CONTRACTOR:
Name oug Q
Name:
Address: A x- r
Company: t Vrt
City:' A P-r 6hl-� State:
Zip Code: 3 4 S Fax: ------
Phone NO. 31 7 - s�(v ` & 19 i E-
Mail: b000®2g0%rCis l
Address: `FGq% Ew. 1q% S 1Q. V
City: 0 sl, J.t : ¢- State: /57f_
Zip Code: �qS �_ Fax:
Phone No 77a-ala—
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail 90 r` `f 0@
State or County License c 13�i 333
t,
If value of construction is 2500 or more, a RECORDED Notice of Commencement is regwrea.
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 HOLD . _ Not Applicable
BONDING COMP 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 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 Cgapty'and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with IeAdhr or an att6rnev before.commencine work or recording vour Notice of Commencement.
Vim —
Signature of ont r - or - Owner Builder as applicable
STATE OF OUNTYOFORIDA�//
Swor �r affirmed) a subsc 'bed before me of
`- Physical Presence or Online Notarization
this�'"rjay of 20Z?�by
4ns
o
Name of person akin�g statement.
`�
Personally Known OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- Stfife of Florida)
Commission No. (Seal) ,►rs�
Notary Public State of Florida
Andrew G Reidy _
i
My Commission GG 347651
apt
Expires0612312023
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Rev 1U/12/21