HomeMy WebLinkAboutBuilding Permit Applicationr -
All APPLICABLE INFO MUST BE COV11_ FOR APPLICATION TO BE ACCEPT
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Date: Permit
umber:
RECEIVED
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Building Permit Appli
ation Permitting Department
St, de county
Planning and Development Services
Building and Code Regulation Division Commercial
Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: 6065 gALSAA r>11VC.
Property Tax ID #:
Lot No. 2�
Site Plan Name:
Block No.
Project Name:
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New Electrical Meter Second Electrical Meter
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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
_ Roof Pitch
Total Sq. Ft of Construction: lv8t} Sq. Ft. of First Floor:
Cost of Construction: $ Jim; °o Utilities: ! Sewer _Septic
Building Height:
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Name inao`i'L
Name:
Address: 4063 IzAt, K, P
Company:
City: S5t- P-t.rGt State: ice.
Address:
Zip Code: ?zLlgg'-Z- Fax:
City:
State:
Phone No. 2
Zip Code:
Fax:
E-Mail: ,' ho '60
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail
from the Owner listed above)
State or County I
icense
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.
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE CO
PANY: 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:
Phone:
Zip: Phone:
Zip:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a perm
t 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 p
rmit 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, 11
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 concurre
cy 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
a recorded in the public records of St.
Lucie County and osted on the jobsite before the first inspection. If
ou intend to obtain financing, consult
with lender or a.t me before commenting work or recordin o
r Notice of Commencement.
Signa re of Ow Lessee/Contractor as Agent for Owner
Signature of Contractor/License
Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF , U)C I -
COUNTY OF
Swor' to (or affirmed) and subscribed before me of
Sworn to ('or affirmed)
and subscribed before me of
Physical Pre ence or Online Notarization
Physical PreSE
nce or Online Notarization
thisq;)_'day of P_ 2020 by
this day of
2020 by
hem
Nam` of person ma ing s nt.
Name of person m
king statement.
Personally Known OR Produced Identification
Personally Known
OR Produced Identification
Type of Identifica ' n
Type of Identification
Produced
Produced
(Signatu of No a Public-
KAREN S. NIELSE
nature of Nota
y Public- State of Florida )
,YPa,
Florida Notary
Commission No. - ,�ission # GG 2074i3t
;20 ��; a�ycommission
b is
mission No.
(Seal)
r' o2X^spir
g;;; Juno 12,
s
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Rev. 5/6/20