HomeMy WebLinkAboutBUILDING PERMIT APPLICATION 3-8-21All APPLICABLE INFO MUST BE Ca�,-'�PLETED FO APPLICATION TO BE ACCEF4.
Date: Permit Number: In
. I
1� 14 ph E
114 R ECEI VED
Building Permit Application..-, MAR 0 8 2021
Planning and Development Services
'Commercial
Building and Code Regulation Division Residential P �i/tting E�apartment
Lucie COUntY
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: 123G AILA&1(0, 0FA13'14 F3LVC2. FT. FJEFR(2C-., T!L, --bQ!m
-
Property Tax ID #: 14314 6CI3 -0c>24 - Oc;'0.7 Lot No. 13
Site Plan Name: Block No. 3,c>
Project Name: Cjteg-j SC-A%QE eVTTA,-,g5
@v N=-
NeV.> S111--LE EALI!:�r qogc-
New Electrical Meter V/ Second Electricall Meter
Additional work to be performed under this permit- check all that apply:
/Mechanical Gas Tank /.Gas Pi ing Shutters V Windo"wts/"Doors Pond
V Electric Plumbing Spri.nk ers Generator Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ SSO y- - 4-6c>K Utilities: —Sewer _Septic Building Height:
rNME NUNN, I NONE I
UNIX
Name DAFR21-� � AMIA cAwf fl
N a t mzl!! le:
Address: [2600 �Vi n"'r C'T..
city: VL[hml Stat FL,
Zip Code: 1710 Fax:
City: State:
Phone No. (365)41G -3084
Zip Code: Fax: .
E-Mail:
Phone No
Fill in fee simple Title Holder on next page if cliffe�ent
E-Mail ()W
State or County License
from the Owner listed above)
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.
- � _J
DESIGNER/ENGINEER:-.------- -------NotAppli
FEE S(MI
Name:
Address:
City:
Zip:
LDER:4--:_ Ni
Phone:
MORTGAGE,COMPANY:
Name: . -
Ad&ess:'-
City:
zip: Phone:
Not Applicable
State:
BONDING COMPANY: Not Applicable
Name: —
Address:
City:
Zip:
Phone:
OWNER/ CONTRACTOR AFFIDVIT: Applicationlis 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 represent ation that is granting a permit will authorize the ermit holder to build the subject structure
which is in conflict with any applicable Home Owne rsJ Association roles, bylaws or anscovenarits that may restrict or prohibit such
structure. Please consult with your Home Owners" Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested perlmit, I do hereby agree that*l will, in all ri�'s'pects, perform �he work
in accordance with the approved plans, the Florida Bbilding 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, Isigns, screen rooms and accessory"u'ses I to anot I her non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
i
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 of Owng-r7T-e-ssee/Contractor as Agent f6r Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTYOF MtokR(-
COUNTYOF
S�rto (or affirmed) and subscribed before me 'of
Sworn to (or affirmed) and subscribed before,me of
physical Presence or Online Notarization
Physical Presence or Online Notarization
thisS2-dayof :2�nu!q�ic� —,20alby
—
this _ day of 20_ by
Name of person making statement.
Name of person making statement.
Personally Known %--� OR Produced Identification
Personally Known OR Produced Identification
Type of Identification I
Type of Identification
Produced
Produced
�,-Wfff&�..�IITAM =RRSRA�
(Sig fo,'�Y6 t a P'bl* �f &1kbimmisSION # GG OVA04
ignature of Notary Public- State' of Florida
Immission
EXPIRES: May 5, 2021
I., Xfvll' Public Underw6te
I
Commission No.M.58C4-1 kD.P� 94gMTO� Notary
No. (Seal)
REVIEWS
FRONT
ZONING
PLANS
VEGETATION
SEA TURfLE
MANGROVE
COUNTER
,JSUPERVISOR
REVIEW
REVIEW
REVIEW
REVIEW_
REVIEW
REVIEW
DATE:: -
RECEIVED
DATE
COMPLETED
Rev. 5/6/20