HomeMy WebLinkAboutBUILDING PERMIT APPLICATION 3-8-22All APPLICABLE INFO MUST BE COMI ..t i CD FOR APPLICATION TO BE ACCEPTED
Date: '? �n-n Permit Number: Za,03-0
RECEIVED
C o MAR 0 g 2022
Building Permit Application St. Lucie County
Permitting
Planning and Development Services
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: 1 ®q30 M f-VCWON) bWC PropertyTax ID #: .3391- 61 - 0037 -00U') SAn,.CI�.� iPAC T Lot No. 37
Site Plan Name: J0930 mg Lewooci L1Vc- Block No.
Project Name: 1' RCED" 12L'S I W AM loW Pp 11 e "
• •WORK*
\do If
New Electrical Meter Y Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
%Mechanical 4 Gas Tank X Gas Piping _ Shutters Windows/Doors _ Pond
Electric %Plumbing Sprinklers ), Generator Roof Pitch
Total Sq. Ft of Construction: (QI 5 La Sq. Ft. of First Floor: 36D
Cost of Construction: $ Wpl,o 00 Utilities: _Sewer )(Septic Building Height: 22 3
O WN ERAESSE E:
CONTRACTOR:'
Name M KK 1- T45 Rr(50
Name: VW C I;Ttigl
Address`:: r/ z3� &PA I LEI✓ NZ,
Company: Tftcs 601I,13C2s
Address: ' b Igo
City: 1' � 2T Sf L-(.iC cc 4'1- State:
Zip Code: 9 $ Fax:
City: PO o (✓' lC State:
Phone No. l b f 15- 15a- 93E-
Zip Code: Rio Fax:
Mail: ``
Phone Noy -n-L) 2-(PC►-460
Fill in fee simple Title Holder on next page (if different
E-Mail LA-,--V-e Ni;- of 16 6-LusoL -1 l'i- , Nb—T
from the Owner listed above)
State or County License C C-IC fS 22l5
IIf value of construction is 2500 or more, a KECUKDEu Nonce oT iLommenuemem 1b ECyuuCu. I
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTALCONSTRUCTION. -LAW) NFQRMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: 6Q L VA&UA Name:
Address: "e Address:
City: Poo-T-sr. 1_.uair-, State: P[., City: State:
Zip: Phone grJ L*a USA 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 O NER: Your failure to Record a Notice of Commencement may result in paying twice for
improvem is o your property. A Notice of Commencement must be recorded in the public records of St.
Lucie Co ty d posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with er ran attorney b work or recording our Notice of Commencement.
S natu of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA c} / , , r
�I
COUNTY OF > f W L 6
Sworn to (or affirm d an subscribed before me of i� Physical Presence or Online Notarization
thi.t?L day of 2by
. MPv—g 9_�
Name of person making statement.
�/
Personally Known OR Produce I ti Ication
Type of entificatiQn Produced -
4/0
(Sig ature o Notary Public- State of FI
u °44 Notary Public State of Florida
Commission No. (Se ; Desiree Flexen
y Al My Commission GG 240686
Ive Expires 07/22/2022
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