HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
97. LL�J�B � RECEIVED
P A- Building Permit Application..MAR 0 9 2022
Planning and Development Services SVtucie ounty
Building and Code Regulation Division Commercial Residential 'Upowu
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 4624578 . CBDG Funding .
PERMIT APPLICATION FOR:. W bi Sc,I,s by +\,,e sec, #a
PROPOSED IMPROVEMENT LOCATION:
a,� ro«. Z� 5� 1 l--1 U4., A 1 1�
Property Tax ID #: Lot No.
Site Plan Name: 1 4 o \�, i scr. +1-e. S to o�i Block No.
Project Name: Q)oz agoL, i S eA # a
DETAILED DESCRIPTION OF WORK:
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: i 5 D O c'� Sq. Ft. of First Floor:
Cost of Construction: $ C`8 S®.00 Utilities: —Sewer Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name 114 _-Wscvz, hV `l ne_ Ses oZ
Name: M � & he, -8/1 S.
Address: 25e c7 H w A
lly
Company: i s T-.c.
City: >'L State: L
p
Address: O • (!bx
Zip Code: S416(1 Fax: IU A
City: ff .��irfLJ i�+'� State: L
Phone No. 5�� q9-9 . 9C LI-2 E-
Zip Code: 333 i0 . Fax: ISCi-773-I o I I
Mail: Ms s o,-,Lo \ W0 _1 veviloo . e eon
Phone No R3`-(- -%6-J
Fill in fee simple Title Holder, on next page (if different
E-Mail M i Ire-aN
from the Owner listed above)
State or County License C (.C, i
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: I
DESIGNER/ENGINEER: _ Not Applicable
Name: . E . P
Address: ` St My41&(te, 1v Jt 51 ;?G
City: ,,- 1,v% V', 1 State: 1=(,
Zip: 7n,(o`d Phone S0- 1y14-"l-lexoo
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
of Applicable BONDING COMPANY:
Name: _
Address:
City:
Zip:
Phone:
Applicable
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 attorney before commencing work or recording your Notice of Commencement.
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLOR A
COUNTY OF3C • LUU e
Swor t d) before
V Physical Presence Online Notarization
(or affir and ubscribed me
of
or
thisday of �faJCt 2CRI— by
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_
Name of person making st ement.
Person nown OR Produced Identification
Typ Identifi do Produced
(Signature of Notary Public- State of Florida)
n U
Commission No. 11 � (Seal)
,tiPiivaim,
?�: ��'G�`;
Notary Public - State of F
Commission GG
GENESIS'NICOLECUB]Assn,
To;
N 2614
My Cnmm. Expires Sep 23
Bonded through National Notar
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DATE
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DATE
COMPLETED
Rev 10/12/21