HomeMy WebLinkAboutBuilding Permit Applicationi
All APPLICABLE INF,P MUS,,T BE COMPLETED FOR APPLICATION TO BE ACCEPTED q
Date: Permit Number:
O �\
Building Permit Application RECEIVED
Planning and Development Services
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Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982 Permitting Department
Phone: (772) 462-1553 Fax: (772) 462-1578 St. Lucie County
PERMIT APPLICATION FOR: �o�e CgrS'� I
Address:
Property Tax ID #:
Site Plan Name:_
Project Name: _
Lot No.
Block No.
New Electrical Meter Second
b -,y.. tit t� -. l�'�,` �+�L A.` r"�•�Vn+ -�'�i: ��E ash -w�`.� r: �' E _�: .. .3 �•�X@.
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Additional work to be performed under this permit— check all that apply:
_Mechanical ` G�a Tank ,Gas Piping _Shutters _Windows/Doors _Pond
Electric _!� Plumbing _ Sprinklers _ Generator ^ Roof Pitch
Total Sq. Ft of Construction: �4 Sq. Ft. of First Floor: A/ i4
Cost of Construction: $ P. Utilities: —Sewer —Septic Building Height:
`e''i'.'�'+i'2�.c�;.4N2„en a Y�ri;y
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Name
Name:
Address: t,!
tea%
Company:
Address:
City:
Zip Code: Fax:
Phone No. _ J14"
State: Ze
v 0'r
ity: State:
Zip Code: Fax:
Phone No
E-Mail
E-Mail- o a1
Fill in fie simple Title Holder on net
from the Owner listed above)
page ( if different
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.
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DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: AJ
Zip: Phone I
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFF`lDVIT: 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 lender nr an n0orney before commondinpr work or recordiniz vour Notice f ommencement.
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Sign ure of Owner/ Lessee/C ntrac or as Agent or Owner
Signature of Contractor/Li c nse Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF sk, 1-v
COUNTY OF
Sworn to (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
this !L day of fO % c. 12020 by
this day of , 2020 by
Sa.bleba "n �lnNN%,� �s
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced D L--
Produced
(Signature of Notary ��I�G;, ate of SJMIE GNt
GG 022023
(Signature of Notary Public- State of Florida )
=�°'"i MY COMMISSION #
Commission No. EXPIR:�a m�r16,2020
= o PublicUndewiters
Commission No. (Seal)
eaFF�o,.• 0n,
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/bj20