HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �1
Date: —� Permit Number:
2 . WOE O . - RECEIVED
Building Permit Application JAN 2 7 2021
Planning and Development Services St. Lucie Cou ty,
Building and Code Regulation Division Commercial Residenti��rmitting < '
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: %) t-}-
PROPOSED IMPROVEMENT LOCATION:
Address: f 70 t; /0At- ON E 77T:2z iV E
Property Tax ID #: �32 1S - �o o�y 0 - Ooc) M Lot No. I
Site Plan Name: Ao 2e5 Block No. )
Project Name:
DETAILED DESCRIPTION OF WORK:
��✓S% AzL�� 7ar-� r3t� /T)s^n/ 72/-I--r- (iZG CAS d2 % 31-)1L` Y r✓C�
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: "l JCC`�C) Sq. Ft. of First Floor: 'CCO'I�r
Cost of Construction: $ -71 . UDC Utilities: —Sewer —Septic Building Height: %U
OWNER/LESSEE:
CONTRACTOR:
Name_`t>i57 MG�i7.-
Address: Ig7o6 M4c � Or'Jla+Z1JC c
City: T(i2( ' % /-✓G c C State: T `
Zip Code: 5119'0-7 Fax:
Phone No. (12 0-7 rc) — S 7L % E-
Name:
Company:
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail
Mail:"by5P,4 • M C G'10 1 L. <O/'l
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License
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:
DESIGNER/ENGINEER:
Name: i1 --- LAND
_ Not Applicable
�2ov//� _
MORTGAGE COMPANY: _ Not Applicable
Name:
City: State:
Zip: Phone:
Address: ' 2 AVEAddress:
City: i yid Staten-�
Zip: q'�,3 `co1 Phoneme 3 - lczsi
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 IPnriPr nr an attnrnpv hpfnrp commencine work or recordine vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDAs4 UI
COUNTY OF •
Sw� (or affir )and subscribed before me of Physical Presence or Online Notarization
thi day of 2�by
In • C a2� Y
Name of person making statement. /
✓�
Personally Known OR P du d entifi ation
Type of Identification Produced
(Signature of Nota ublic- State of Florida)
AUDREY B. NUMPFIREY
`=ot�Avaya`c ;'
MY COMMISSION # GG 300II17
*:
Commission No. (Seal) '*' ,
�..Q, EXPIRES' March 6, 2023
%,Z' •,E OF F�O.� Bonded TLru Notary Public Underxriters J�
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Rev 5/20/21