HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1�aG+`a� Permit Number: aka d \
RECEIVED
Building Permit Application JAN 2 6 2021
Planning and Development Services
Permit no D artffi@fit
Building and Code Regulation Division Commercial Residential 91• c COWitV
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
Address:
PropertyTax ID#: �3a�o - V\ -C�c�d 1~�da d-� Lot No.
Site Plan Name: Block No.
Project Name:
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 _Roof Pitch"
Total Sq. Ft of Construction: f aZ Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
Name 5d k �.J 1� )�"�,.J Name: �.l �
Address: I Company: L
City: �i' c/ CC State:f Address: a39 9
Zip Code: Fax' City: 7- �e/'c :C Stater
Phone No. Zip Code: '� _ ( Fax:
E-Mail: Phone No ` Z2 z - I - /33 )
Fill in fee simple Title Holder on next page(if different E-Mail W4T'e �S d Q f2
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.
/ 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 yourdeed 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 or an attorney before commencing work or recording our Notice of Commencement.
Sighature of Owner Less—ee/Co ntr-a ct3p4s Agent for Owner Signat a of Con ractor/Lic se Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 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
thi=' <a day of 1C14\ 20a.\ by this Qo day of 20a.J by
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 Identifi�at
Produced L- Produced ��
10 A A A K
(Signs ure o (Signature of Notary Public-State of Florida)
KAREN S. NIELSEN
B'-- KAREN S. NII A
Commission _° ` :State of Florida N��}}ii�ar1l{�,'Publ�c Commission ��1�YP�B�-i
_ sion # (��2'0�/484 _ �, lorida-No ary ublic
9r P My Commission Expires
- Commission # GG 207484
June 12, 2022
o"� � June 12, 2022
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