HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE C0Nw;6ETED FOR APPLICATION TO BE ACCEPTEu �� JJ��
Date: ` (ID' Permit Number: aao D-- Q CO
'nsR U�� r RECEIVED
Building Permit Application
FEB 2 3 2022
Planning and Development Services
Building and Code Regulation Division Commercial ReSldenIeu"' County
rmittinp
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
Address:
Property Tax I D #: p�� �,�-i ' � Oa` 6 0 0 — Lot No.l 1 I I Z
Site Plan Name: �''^� �� _ Block No.
Project Name:
AILED DESCRIPTION :OF WORKS ;
1QL1 C.OkcnvTT 1,2x qD �to IL ,,Overe.�� .CIGL
�C)Ga pST
New Electrical Meter Second Electrical Meter
(Affidavit required)
CONS'TRUCTIONFlN'FORMATI'�'N�' - � -
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank _ Gas Piping — Shutters
_ Electric _ Plumbing — Sprinklers
Total Sq. Ft of Construction:
P
COst�� 4strctetion� d �/
Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Utilities: —Sewer _ Septic Building Height:
OWN'ER" �ES�SEE� : r
CQ�N_T_t�ACTOR
Name wh
Address: LA 'A 11 t�reS�fly Lev.!
Name:
Company:
Address:
City: 1 1%L- State: °—
Zip Code: 3g0Y% a- Fax:
Phone No. 'D1 —21Lo "— Sq 52 E-
Mail: �NaW 23A q Cdornc n+ ;real-
Fill in fee simple Ti le Holder on next page (if different
from the Owner listed above)
city: State:
Zip Code: Fax:
Phone No
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.
r
SUPPLENiENTAL,CONSTRUCTtOI�t L{EN L 'W �NFORMAT{ON
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: 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 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 lender or an attornev before commencine work or recordine vour Notice of Commencement.
Contractor. .- or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF ' _13C�,it .
Swor to (or affir d)"and subscribed before me of Physical Presence or Online Notarization
this day of 2(dy
Name of person making statement.
Personally Known OR Produced Identification
L.
Type of Identification Produced. 9, t' �
(Signature of Notary Pub is -State of Florida)
Commission No. (Seal)
, KAREN S. NIELSEN
` PY PU i
qP B i
;ate, ��;state of Florida -Notary Pu is
# GG 207484
Commission
My Commissio2n02xPires
June 12.
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