HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
*a'\ Permit Number:
91ro WOE RECEIVED
O
p- o o :.... ]AM 15 2021
Building Permit Application
Planningand Development Services Permitting Department
P I$�: Lucie County
Building and Code Regulation Division Commercial Residential Q�
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: S U20 O
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Address: LQ's _--mQ-�'
Property Tax ID #: \31- ��1� ���`)Q;`�O Lot No.
Site Plan Name: Block No.
Project Name:
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CSC'
�J�ctric I et r�®(�—�Qt'Iic
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:
Cost of Construction` UKA] ,. _
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic
Building Height:
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CON'TRA�CT®R���r��
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Name:
Company:
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Address:
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Zips Code: t��J Fax:
Pihone No.
l==Mail: �'"l
i
i=iltlimfee simple Title Holder on next page if different
from the Owner listed above)
City: State:
Zip Zip Code: Fax:
Phone No
E-Mail
State or County License
If value of construction is Z5oo or more, a KtGUKUtU INOUCe or t.umrnenccin mi. u i cyu I ou.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
DESIGNER/ENGINEER: — Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone
Zip: Phone:
_J
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and instanauon as muaaLCU.
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 restrictor ohibit 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
F.r. ,A,,,rie r,r rcrnrriina your Notice of Commencement.
with lenaer or an a LLorney be uIC I "__i n.1 IIF,
ign refowner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA rr =
STATE QF,(ri:OzRlDi
COUNTY OF ��- l Uri -e
TY O
COUNF
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 me _= 2020 by
this day of 2020 by
Name of person making statemen .
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of identificatioL�-
Type of Identification
Produced v r
Produced
No
- L UG N N
(Signature of Notary Public- State of FloridaV
:(Sig:natu7reof
No.
i,°�State of Florida -Notary Public
=* •= commissions 9e 270079
Commission No. (Seal)
0F F`OQB� My commission Expires
Ali r \ October 22, 2022
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Rev. 5/bj21J