HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE CUM- ED FO
R APPLICATION TO BE ACCEPTED
Date:
Permit Number:621 () r � v � J
RECEIVED
JAN 2 5 2021
Building Permit Application Permitting Department
L ' C t
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
Property Tax ID 4:
Site Plan Name:
I S iA) 1)
Project Name: D�C R
v,
New Electrical Meter,AOX.&O Second Electrical Meter �v
St. ucie oun y
Residential
Lot No.
Block No.
Additional work to be performed under this permit -check all that apply:
Mechanical MO Gas Tank W Gas Piping AOV Shutters _ Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
Name po tAA410
Address: 540/ -S� INDj*&V A 04
City: or.91 % � PV??4,tk State:
Zip Code: 3�/94F2 Fax:
Phone No. 7772. 9 H 0 = 7`7
E-Mail: f5�iv; -r'r E� &A CU�LGA'&
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above) _/
Name: N�
Company:
1 ,,,I;, ;,, i
Address':
i!, State:
City: ,,,� ,, � ..
Zip
Phone No
E-Mail
State or County Licen
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.
CzRfEKIziEMELTCE (jvn .W
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 onthe jobsite•before the first inspection. If you intend to obtain financing, consult
with lendeLor an attorney before corrimencing work or redording your Notice'of Commencement.
Signs ure of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder,
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF !S4- L,J
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
V Physical Presence or Online Notarization
Physical Presence or Online Notarization
this ��day of �?J 20 by
this day of , 20_ by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification f
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced_b&�
Produced
(Signature of Notary
Public- St e of Florida)
(Signature of Notary:Public :State of Florida •)—
Commission No.
`�ti�,pY PV'�i H E AT H EI,I�IdRFORD
RFtar
�o a�- of Flon
1 (Seal)
Commission No.
a Public
'= Commission # GG 183217
j P`
0, P . M
February 06,
2022
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