HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ^ e2�O_&3, Permit Number: oL� •"[)�
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Building Permit Application
St,Lucie County
Planning and Development Services Permitti
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:
PROPOSED IMPROVEMENT LOCATION:
Address: n 6 A u n
Property Tax ID#: G406r1)01- Lot No.
Site Plan Name: Block No.
Project Name: npjMns Pro i eel
DETAILED DESCRIPTION OF WORK: e .,
ep�ac� 50 gallon UUC,6er h)COJte-r E IeCAHG
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCT1 N 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: $ 1i Utilities: —Sewer _Septic Building Height:
OWNERAESSEE: CONTRACTOR: ` 1
A
Name �kearoir\ �Q.N05 Name: i s
Address: 3GOS Nve nue I-- Company:'`G01 &ree Ockj (PI,7 o`(
City: Fn r-) P I e;T-Ge- State: FL- Address: otoi &reen ()101-i
Zip Code: ?, t-IG`-d 1 Fax: City:90M Da no State:
Phone No. rl n 2'Hn6f'6 5S i E- Zip Code:_' 3 0Cvt1 Fax:
Mail: Phone No q S y-?_'-42"2SkC)
Fill in fee simple Title Holder on next page (if different E-Mail 5(arv► ne_f)Q.5iMM ft f..f SC-GDM
from the Owner listed above) State or Co my License C FC N V;0'0CJ
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.
SUFPLEII/IENTAL 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 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 FLORIDA
COUNTY OF 2:,(-OWCJ-6
Sworn to(or affirmed) and subscribed before me of Physical Presence or Online Notarization
this ?10'aay of 201Z by
Name of person making statement.
ONENA NICOLE SI MS
Notary Public-state of Florida 08r 8]
Personally Known OR Produced Identification *E Commission#HH 220898
Y CornmissionExpires
Type of Identification Produced January 25,2026
(Signature of Notary Public-State of Florida)
Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 10/12/21