HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE.COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ?f) Permit Number:—Za2z--O-Sq�
RECEIVED
DEC 2 2 1010'
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Permitting Department
Building Permit Application St. Lucie 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:
'PR®P�OSE+sIR PRO0/
ddres`E�NTLO
As:.
_,op �- Lot No.
GP.�ope.rty Tax�I R::#
Site Plan Name: Block No.
Project Name:
New Electrical Meter Second Electrical Meter
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�COySTRU�TtONI' F®�R`M'ATI®N��,�._
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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
TotaJ'.Sq Ft of�Costrustor `1 ca Sq. Ft. of First Floor:
sof4Construcoion:$�-�Z�c� _ Utilities: _Sewer _Septic Building Height:
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Name n! w/ Name:
Address: IVN fs - Company:
ja2 State: _ Address:
Zip Code:.119 S Fax: City: State:
hone No. 3 6 Zip'Cod'e: Fax:;
LE11
Mail: l" :ANi/b.Phone No
in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) 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:
_ Not Applicable
MORTGAGE COMPANY: _ 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:
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.
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
..:+L. L....J ... r.-.++r�rrve�, hofnro f-r%m �,nnr�inv %Ainrle nr rprnrding your Notice of Commencement. \
WILII ICIIL.ICI VI all CILLVIIIc Llc, v,c •.v„n,..., ...... ......
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-rsignatUreof O nor/ Lessee/Contractor as A ent for Owner
Signature of Contractor/License Holder
STATE OF FLORID
STATE OF FLORIDA
COUNTY OF
COUNTY OF
Swo to (or affirmed) and subsqkbed before me of
Sworn to (or affirmed) and subscribed before me of
P sical Pr ence or Online Notarization
by
Physical Presence or Online Notarization
this day of 2020 by
this day of 2020
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
Produced
(Signature of Not -
(Signature of•Notary'Public-.State of Florida) .
11,,,, KAREN S. NIELSEN
Commission No. a�"�yP`State of Flo(Faallotary Public
f'
'Commission No. (Seal)
=+ r Commission # GG 2074834
My Commission Expires
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MANGROVE
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DATE
RECEIVED
DATE
COMPLETED
Rev. 5/ b%LU