HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 11
Date: 3121 Is S Permit Number:aao � r ®V �, 0
J . WOE �� RECEIVED
O
` = � Building Permit Application MAR 0 7 2022
Planning and Development Services
Building and Code Regulation Division
.2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial
CBDG Funding
St. Lucie County
Residential Permrng
PERMIT APPLICATION FOR: S�e .�M ��� 1�5��
PROPOSED IIM/�PROA'VEM�E/�N/yT LOCATION:-,
a rimer• 1 /i cu UV . ! 1� I ke' 'nrll A YI oye✓te Pt -�McI41 .
PropertyTax ID #: 23o5- Soo— Op03 — 000— 8 Lot No. 3
Site Plan Name: CTrrtl A es ►dtnGe, Block No. —A
Project Name:
1';[)ETAILED:,PESCRIPTION,.OF'.WORK:,;l,, ,
Coy),5WIact a 4 bedrwnr 3 batvN 5inale, famr-eSi ence,
a ccxx old pt, e�
New Electrical Meter X Second Electrical Meter.
CONSTRLICTION INFORMATION:,
(Affidavit required)
Additional work to be performed under this permit —check all that apply:
X Mechanical _ Gas Tank _ Gas Piping _ Shutters
'X Electric X Plumbing _ Sprinklers _ Generator
Windows/Doors _ Pond
Total Sq. Ft of Construction: 0 t -1C, Sq. Ft. of First Floor: _
Cost of Construction: $ 51-4 , CL I C) Utilities: —Sewer X Septic
X Roof Pitch
Building Height: ZZ/
,OWNER/LESSEE:
CONTRACTOR:
Name_ 1 pbeyk "a A0%0',Y\Y _ t4oat
Address: PO 'BOX 1111S
City: Ft My-ce State: F I
Zip Code: Will Fax:
Name: -Tames I n-W riRly,
Company: -T(eWYV'Y Cons-�YL . q' h Im.
Address: VRPO (',Openlnayey Ad
City: P+ lovCI 'ce. State:
Phone No. E-
Mail:
Zip Code: 340M5
Phone No 11 a 1;10X
Fax:
CIsd33
Fill in fee simple Title Holder on next page (if different
E-Mail 71'Ye f0YXY U)
MiK1 A.0 K10Y%®Vah00.
State or County License
2&o00
from the Owner listed above)
IIf value of construction is 2500 or more, a RECORDED Notice of Commencement is required. I
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
.SUPPLEMENTAL CONSTRUCTION LIEN LAW INPORMATIOiV:
DESIGNER NGINEER: Not Applicable
Name: a%x R- VG e a
MORTGAGE COMPANY:
' Name: ea. Cuas'
r1 Not Applicable
ecxn�
Address: 1
A
Address: VICID 5VA
City: 7V, S4
&0Abn swa.
State: P
City: Stater_
Zip: 3 Phone 712-
1- ZyS'7I
Zip: 34CI53 Phone:
-1l2 - 42' 0345
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.l 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 ano posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender orlih attornev before commencing work or recordine vour Notice of Commencement.
1-JI/I /
Signatu f Contract - or - Owner Builder as applicable.
STATE F FLORIDA
COUNTY OF L%Ac,%eJ
and subscribed before me of X
Sworn tq (or affirmM(ArCh
Physical Presence or Online Notarization
this � day of2021 by
'Tfeft�W
(Io�mes
Name of person making statement.
Personally Known X OR Produced Identification
Type of Identification Produced
�s WJJA' 0, .. ""
(Signature of Notary Public- State of Florida) V 4
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uy,1 AMANDABEtHdIAGGARi
Commission No. I4H 00903 (Seal)
: Commis W#HHCOW
Expires June 10, 2024
ti.,o:a�Q.• Baded7WDay Fah lnturenoe600. W7018
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