HomeMy WebLinkAboutBuilding Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 U J a;t- Permit Number:
lwlw lRECEIVED
Building Permit Application MAR 2.9`2022
Planning and Development Services St.• . ie County
Building and Code Regulation Division Commercial Residential miffing
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 CBDG Funding
PERMIT APPLICATION FOR:
Address: - --1Q_' I(-rw1 - - I - -n +
Property Tax ID#: 130k - (00(0 -0a Ll H- boo- I Lot No.
Site Plan Name: A CIL 10--T Block No. )L{
Project Name: )ct 9104Ar
D;ET7AILEDEDESCRIPT•ION OF WORK
x
2._._.__:__emu.;:._ _s a:=. _.w._._
jSWL%51-c of+ f0t4-41 OA R—fa3f - Yyu f l CodiR• Uf 4-k fib
FL Pray cl- 4-fP q 5q,6-: 15 k S` Sh vkSL', r Roc!-Or- Arp
New Electrical Meter Second Electrical Meter Affidavit required)
CONSTR CTION 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 C Roof 5 ;L Pitch
Yaa
Total Sq. Ft of echstraction: Sq.Ft.of First Floor:
Cost of Construction:$_ ;I G? Utilities: _Sewer _Septic Building Height:
c.-z-'-' - mot -L zz,,,e--rC®NTR_ ACTOR... ....t,._..-f.,* _?
Name ._) tUi-P J_ L )!aileIL Name: ) L tic lh PM .S SiC zeriSd7 Ga
Address: r2 ee-,\ Q )l 'l Y? S Company: h L C4'1fV Vs
City: P4. { i e rG- State: L Address:'N 013 HWY l
Zip Code: J4gS-j Fax: City: V+u gt-yrh State:--
Phone No. `77:Q-- (D/— E- Zip Code: -&L70-- Fax:
Mail: il to I+q 01, 8-dmcggf. v eJ Phone-No -:7 ra_S3g'96
Fill in fee,s'Title Holder on next page(if different E-Mail h lu'Ga-i4-nd-&-s . Conn
from the Owne 'sted above) 7,? State or County License
If value of constr c(ion is 2500 or more,a RieCORDED Notice of Commencement is required.
If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMEIVTA'LCONST`KU5l7"IOIV LIEN LAW`INFORII/I Lk, I041V x c "Ys
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: tate:City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMP A Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: one:Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made t obtain a permit to do the work and installation as indicated.
1 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 structurewhichconflictswithany,applicable Homeowners Association rules,bylaws or and covenants that may restrict or prohibit suchstructure.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,consultwithlenderoranattorneybeforecommencingworkorrecordingourNoticeofCommencement.
Signature of Contractor- r-Owner ilder as applicable
STATE OF FLORIDA
COUNTYOF 1n&.,v IZcVc
Sworn to(or affirmed)and subscribed before me of Physical Presence or Online Notarization
this 9LI day of 6ir 20_a by
Name of person making statement.
Personally Known e OR Produced Identification
Typ i ica ion ed
Signs urn ry Pu c-State of Florida)
pp,,,, Jill K.Samberg
mission No.I ra5`tq 6? (Seal)
P/*CE1SP:
NOTARY PUBLIC
STATE OF FLORIDA
Comm#GG254409 .
Expires 8/30/2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev