HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICA LE INFO
MUST BE COMPLETED FOR AppLlCgTION
Date: '� Z3 �D
TO BE ACCEPTED
o L LaLU,�ri
Planning and Development Building Permit A
Serv'
Permit Number. Q0
-� �-, 0
RECEIVED
Buildingand Code ices pp (Cation MAR 2 3 2 22
Regulation Division
2300Virginia Avenue,Fort pierce FL34982 COmmercial St. Lucie ounty
Phone: (772) 462-1553 Fax: 772 462-1578 Residential P ing
( ) CBDG Funding
PERMIT AppLICATION FOR:
2L- u.TuS.EED:1'MPRO.V ME,NT.' LOCAIFON:
Address:
Property Tax ID #: 3 r
Site Plan Name:
Project Name: Reer .C!
D'ETA'ItED' '
!TIO.N,OF :WORK::
New Electrical Meter__ Second Electrical Meter
CONSTRUCTION' IN'FO`RK4 NTLON
Additional work to be performed under this permit — check all that apply:
_Mechanical — Gas Tank _ Gas Piping
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:_ �� ° \ '5!k
FA —
Lot No.--A—
Block No.
Shutters _ Wind /Doors — Pond
— Generator Roof 3 . C Pitch
Sq. Ft. of First Floor:
Cost of Construction: $ —B4k-Q Utilities: —Sewer _Septic
OWN-ER'/LESSEE.:
Name U Ke-
Address: LAI 15 LrAkes�&-- a
City: 1�,,`L-I„ State: mil.
Zip Code:.jkA \ l Fax:
Phone No. ) 1 30\ �'jp(a E-
ntail: A)k/(djkr.41-_ /n-- -
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
NTRACTOR:
Building Height:
Name: ° ,c—:'�
Company:
Address: BSr�
City: Qv* State: -L
Zip Code:. c;Qc-igt4 Fax:
Phone No_ `J-J 2 3 D i C1 9 (p3
E-Mail !PC<mi-NS (!;� �Y.'MM�a(('�rG •ca.�
State or County License C� 1 —2g
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.
SU-PP`LEIVIEN&A'L,CONSTRUCTION UEN LAWJ.NFORMATIO.N
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY:' _ Not Applicable ^
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
_ Not Applicable
BONDING COMPANY: Not Applicable
Name: _
Address:
City:
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 failur6 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 vour Notice of Commencement.
R:
y
Signature of ner/ Lessee/Contra , or as Agent for Owner
STATE OF FLORIDA'
COUNTY OF 9��("�; P,
Sworn to (or affirmed) and subscribed before me of V
Online Ph sical Presence or yNotarization
this day of 11` kar-('XZ , 2022,by
ent.
Name of person maki7:0R
DENISE E. SUAREZ-PAGAN
Florida
Personally KnownProdtirpd Irfentification
=_ ^Notary Public -State of,
# HH 218518
_
Type of entification Produced
._ Commission
H, P�� My Commission Expires
_
�n /07,
October 13, 2024
(Sign A ture o otary Public- State c T Flor
Commission No. V+j- V `b'SIt(Seal)
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