HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Numbe •
L,i�h.L� RECEIVED
Building Permit Application MAR 0 2022
Planning and Development Services 9t, Lucie County
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-
BuildingondCodeRegulotion.Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: ` 00' 1�
PROPOSES�liVfPRC►VEMENT-•LOCATfON.. :_:..__... _..... �,,..._.. _:..._.T._<_.:..- .� _-..-:.�.._......_..._._.._v_._
Address:
41 1 PYnS
17 V is
Property Tax ID-#: f' S�� %-'� �b� I oZ Z ` bDO -- I' tot No.
Site Plan Name: C eCe� e_ Moct) 1 -,�_ j Block No.
Project Name: S''ReelY_
QETAILED DESCRIPTION--OF-WORK..= -.- - -
nS')a Ik �T�
(,r, ( k R ZR oc. i TA
L 1 T"
New Electrical Meter Second Electrical Meter
(Affidavit required)
CONSTRUCTION INFORM -T- ION
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: S Sq. Ft. of First Floor:
Cost of Construction: $ ��� 0 Utilities: —Sewer —Septic Building Height:
-OWNER/L;ESSE_E:.: r;.. .-=,; _.. -
.CONTRACTOR.::-
Name %A 1 Wc1 J 4
Name
—liCe.
Address: I o 99- ) l C ✓Z
Company:
Address:
City: State:
Zip Code:. Fax:
Phone No
City: 3(,vge". % tciel, State: r
Zip Code: 349S7 Fax:
Phone No. %jar 63� E-
Mail: `°,C C e' C e- i ,1 ep) G y-h c , I . C�%t--,
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
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.
L
511PPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION
1f,t ..-, .w ^.a?S 1. ;w'•
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DESIGNER/ENGINEER: _ Not Applicable ry MORTGAGE COMPANY: _ Not.Ap.plicable
Name: Name:
Address: Address:
City: State: City: State:
Zip:, r Phone Zip: Phone:
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 consullt 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 lender or an attorney before commencing work or recording your Notice of Commencement.
Signature Contracto - or - Owner Builder
of as applicable
STATE OF FLORIDA
-�
COUNTY OF M BRA Y1
/
Sworn to (or affirmed) -and- subscribed, before me of d
Physical Presence or Online Notarization
this day of M1PA- 1 20__ZZby
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced r—A 17y
(Signature of Notary Public- State of Florida)
Commission No. ; 450Pye°•;
&qH 3 (Seal) b• �
DEBORAHVINCESLIO
• ` _
�•�
Notary Pubiic • State of Florida
N GG 914343
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Commission
urtti`
My Comm. Expires Sep 18, 2023
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Rev 10/12/21