HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMI°-_y_,4ED FOR APPLICATION TO BE ACCEPTED rS
Date: .�oZ Permit Number:OR 2/•
RECEIVED
O �1
Building Permit Application MAR 0 8 2022
St., Lucie County
Planning and Development Services Permitting
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
Property Tax ID #: �3 3A l ' S01 ~'60 3'7` 6 d o—I CIZC�rC k&6-7-Y Lot No. 37
Site Plan Name: JQ9 3Q�J �
&Y/_0MOdn J_&I be Block No.
Project Name: � 9G'0 `/�-e$ Jncw6c 6 acS7" 1fPa5E
DETAILED DESCRIPTION OF WORK:
_ C Uc-- 5T /fit) uSr CAS 61)Nsr, rWrr _'7MI2/t U U)111),QMf
a6:enzlC WlL-C %r PIILGC-D 114A7n1 177)USe a) 51_t1tE
New Electrical Meter
CONSTRUCTION INFORMATION:
I Meter
Additional work to be performed under this permit- check all that apply:
(Affidavit required)
`Mechanical _ Gas Tank —Gas Piping _ Shutters X_ Windows/Doors _ Pond
Y\ Electric X Plumbing
,,ll _ Sprinklers _ Generator X Roof 5�/Z- Pitch
Total Sq. Ft of Construction: q&) Sq. Ft. of First Floor: ,
Cost of Construction: $ 11&, 250 Utilities: _Sewer X Septic Building Height: �0�5
OWNER/LESSEE:
CONTRACTOR:
NameA4All _I -i gas eew
Address:
Name: N17WJ
Company: Tbtsc
City: Poelrs1`-WCi State:
Zip Code: MFax:
Phone No. E-
Mail:
Address: ghhh
City: (-;btfs W ur— State: '
Zip Code: 1-349 Obp Fax:
Phone No_a77-) 2(po-
E-Mail P-A-T120N15- l 6 r�6LO - tJ15T
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License C(,-f152Z 15(J
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 CONSTRUCT,.IO.N UtN•LAW INFORMATION ,
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:L16AAi I QfiuL MlY:i1h Name:
Address: i; Address:
City: Sfi 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 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 attornev before commencine work or recording vour Notice of Commencement.
lgn toe of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA c a
COUNTY OF
Sworn to (or affirmed) and subscribed before me of �C Physical Presence or Online Notarization
this aL day of P E--B , 2030'by
,fy� ftpv—
Name of person making statement.
Personally Known OR Produced ldentificatio
Type of ntification Produceci<
(Sig ature of Notary Public- State of lorida)
Commission No. (Seal) =0 V °Uey' Notary Public State of Florida
Desiree Flexen
y 8` My Commission GG 240686
OF V%e Expires 07/22/2022
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Rev M/12/21
PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772)•462-1553
FILLED LAND AFFIDAVIT
I, the undersigned, am the owner of the following described property,
3321-501-0037-000-1 10930 Myrtlewood Lane Port St Lucie FI 34986
(Parcel Id#/Legal description/Address)
for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development Permit, BP Number , I acknowledge
that as owner of the above described property, and in accordance with Section
7.04.01(D), St. Lucie County Land Development Code, I shall be responsible for assuring
adequate drainage so that the immediate community WILL NOT be adversely affected.
I further acknowledge that in granting this permit for the development of this property,
St. Lucie County is neither obliged nor liable to provide for, or maintain in any form,
adequate drainage off my property which will not adversely affect the immediate
community.
J
Name (Please Print)
Signature
V- LJ
Date
STATE OF FLORIDA, COUNTY OF 131— U67
ACKNOWLEDGED B ORE ME THIS DAY OF 20
ey
BY ffrd- KOO) WHO IS PERSONALLY KNOWN TO ME f 0 OR WHO HAS
PRODUCED I L
"�qz/w—
SIMMM OF NOTARY P LIC
COMNIISSIONN&BER
SLCPDSD Revised 04/11/2011
AS IDENTIFICATION.
-beg/ 4-� R
TYPE OR PRINT NOTARY
,p (SEAL)
Yo�yar pcty4� Notary Public State of Florida
Desiree Flexen
< My Commission GG 240666
Vpof ve Expires 07/22/2022