HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:a-Permit Number: a 16 a.'C36
RECEIVED
.. O
FEB ' 3 2021
Building Permit Application -rt
artment
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Permitting Dep
St. Wda .ounty
Residential
PROPOSED IMPROVEMENT LOCATION:
Address: c5 c-/ e 6 /U 141/6- f0 OZ / P&-10Cie
Property Tax ID#: f)0 /3 —DDeJ
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter A: Second Electrical Meter X
CONSTRUCTION INFORMATION:
Lot No. a
Block No.
Additional Additional work to be performed under this permit —check all that apply:
Mechanical _XGas Tank XGas Piping ZShutters �C Windows/Doors _ Pond
Electric Plumbing _Sprinklers XGenerator �oof Pitch
Total Sq. Ft of Construction: rX, Sq. Ft. of First Floor:�/J
Cost of Construction: $ ;�d , A'ol Utilities: _ Sewer ZS^eptic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 124NN \l B 6 7 JJvO
Name:
Company:
Address:
Address:,, pd }rD09i f �1�2C�� L(/7
City: rad r State: 4t
Zip Code: 3 � Fax:
City: State:
Phone No. 77,2 % `Q %
Zip Code: ax:
E-Mail: r 6 / _/J0 %
Cd M
Phone No
E-Mail
Fill in fee simple Title Holder on next page (if
different
State or County License
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 CONSTRUCTION LIEN AWINFORMATIO.N:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
Address: I
Address:
City: State: i
City:
State:
Zip: Phone I
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY:
Not Applicable
Name:
Name:
Address: I
Address:
City: I
City:
Zip: Phone:
Zip: Phone: I
I
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 pi for 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 is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners 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 Recordla 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
witWre-n'ler or an aternev before commencine work or recordine vour Notice of Commencement.
Sign a of OfKerl Lessee/Contractor as Agent for• Owner
Signature of Contractor/License Holder
STATE OF FLORIDA I
STATE OF FLORIDA
COUNTY OF S=t. Ly c
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presenc or Online Notarization
Physical Presence or Online Notarization
this � day of c 2024 by I
this day of , 2020 by
Name of perso making statement.
Name of person making statement.
PersonallyKnown OR Produced Identification
Personally Known OR Produced Identification
Y
Type of Identification I
Type of Identification
Produced '�L_ 69L••-
Produced
I
i
I
(Signature
(Signature of Notary Public- State of Florida )
�Tavr�'••
;�q.•-�-•�,; AUDREYB.HUMPFIREYI
Commission N '*: .: MYCOMMISSIONf;��,p817
I EXPIRES: 1
Commission No. (Seal)
March 6, 2023
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Kev. b/b/20