HomeMy WebLinkAboutBuilding Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
ST. LUCIE
COO C.I NT�Y
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial 1 Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
WY
of US
Property Tax ID #: ✓°-�,,� `t7!2 ---5'4 , 7 Lot No.
Site Plan Name: P p C�S� Block No..
ProjectName:
11/161VIA� l /V ol-- 4VC,
New Electrical Meter Second Electrical Meter
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 SIX
Pitch
Total Sq. Ft of Construction: `'g"oC) Sq. Ft. of First Floor: �' `X
Cost of Construction: $ 4c5 co. w Utilities: —Sewer ;�"`Septic Building Height:
Adel
I
T
State:
Phone No.
E-Mail: h-
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: J erweS 6ai ffl,4
State: rL
Zip de�flO -Fax may' : _
Phone No
E-Mail .i �1r Ga1'n
State or County License _$ G 0SW'i/o
it 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.
DESIGNS
Name:_
Address:
City: _
Zip:
GINEER: _ Not Applicable
Phone
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
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 is in conflict with any applicable Home Owners Association rules, bylaws or and covenants 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 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 lenriPr nr an gttnrnav hafnro rnmmanrina Wnrlr nr me ^rrli— yr —AID,+ire _; C�rrrrerre rrer.t
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Owner/ Lessee/ ractor as Agent for Owner
SignaturtFFLORIDA
Signatu of Contractor/Lice s Holder
STATE
STATE OF FLORIDA /
COUNTYOF
COUNTY OF cS� /�-►iG�
Sworn to (or affirmed) and subscribed before me of Xtnes
. worn to (or affirmed) and subscribed before me of
�Phy5ical Presence or Online Notarization
this 2"aday of SL'Df 2020 by
�hysical Presence or Online Notarization
this2�l day of Pw1 /' 2020 by
13,
Name of person making statement.
Name of person making atement.
Personally Known a/ OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produc d
(Signature of Notary Public- State of Florida)
(Signature of Notary Publ'
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Commission No. "AfyEMOMENT
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MYC ION#GG947135
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:�• off: EXPIRES: February 6, 2024
•• _ 'O EXPIRES: 6 2024
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