HomeMy WebLinkAboutBuilding permit app All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Datt�e:��77 '1 20 Permit Number:
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7 Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue,Fort Pierre Ft 34982
Phone:(772) 462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
9
Address: rl&l w. le 0 F P - FI 349¢L
Property Tax ID#: 34oz -(O0 p- 0 Z rrq -Ci0 o ,3 Lot No. 71- Z r
Site Plan Name: Block No.
Project Name:
)fen r L'4 e r Col 4 u 7
New Electrical Meter Second Electrical Meter
A.
Additional work to be performed underthis 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: Sq. Ft. of First Floor:
Cost of Construction: $ 42 UCU Utilities: —Sewer —Septic Building Height:
Name IVrsfiL Name.-
Address: S` O!t wryr*%e Or Company:
City: 02, P:e(� State: f� Address:
Zip Code: SL x: City: State:_
Phone No. �7 - 7Fa05-1 Zip Code: Fax:
E-Mail: eiedI .te Pe._ Phone No
Fill in fee simple Title Holder on nest page I if different E-Mail
from the Owner listed above) State or County License
If value of construction is 25DO 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.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
Gty: 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 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.
Inconsideration 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 recordinp your Notice of Commencement.
ignature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA r STATE OF FLORIDA
COUNTY OF WLGC/'--- COUNTYOF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Pinsical Presence or O Ilne Notarization Physical Presence or_Online Notarization
this day of 207A by this day of 2020 by
�?I,. 10
us�er
Name of person making statement —r Name of person making statement.
Personally Known OR Produced Identification_ Personally Known OR Produced Identification_
Type of Identification Type of Identification
Produced Produced
e I 1
Jatu
v a (Signature of Notary Public State of Florida)
.:_ ELLEN VA UG II{{Grata of Florina-Nb\@i}I pCommission No. (Seal)
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