HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: %/001aI Permit Number: �l
ST. LC.ICI E
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Building Permit Application
RECEIVED
JAN 112921
Permitting Department
St. Lucie County
Commercial Residential V
Ad r s� 3 � 3 (o S �r®c-e��rn►�in � -
PropertyTax ID #� 50 - C700 (00C�� Lot No. 5
Block No.
Site Plan Name: --
Project Name:
New Electrical Meter Y'lA!a Second Electrical Meter n\G
Additional work to be performed under this permit -check all that apply:
Mechanical _Gas Tank _ Gas Piping _ Shutters — Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Gam- Cost�of�Constr-action: $ nJOof
Generator
Sq., Ft. of First Floor:
Utilities: _Sewer _Septic
Name 1UU%1Y A Acr
Address: 3151051 0C y%-Y4 n
City: IrD V� -e rGe State
Zip Code: Z '� �A45 Fax:
Phone No�l'1' alo1•L*\-1
E-Mail: A4 Y19!! �r ®C412i • (-Orr"'
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:
Address:'
Citv-
Zip Code:
Phone No
E-Mail
State or County Licens(
If value of construction is 2500 or mare, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
Roof . ;-Pitch
Fax:
DESIGNER/ENGIN
Not Applicable
Name:
Address:
City: State:
Zip: Phone
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: :4 City:
Zip: Phorae:o,, _= '..
Phone:
'IWNFR/ ra
ADoli
de -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
b f ommencin work or recordin our Notice of Commencement.
with lender or an attorne a ore ctZ
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF �l�
COUNTY OF
%o to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
t Physical Pres nce or Online Notarization
by
Physical Presence or Online Notarization
this day of 2020 by
this LA_� day of JfIT4 202
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification e
Personally Known OR Produced Identification
Type of ldentificwagp
Type of Identification
Produced
Produced 1..
AA
(Sig ture of Notar b' -
(Signature of Notary Public- State of Florida )
`PyPU// KAREN S. NIELSEN
Commission No. .moo`" B<%': State of Flor(d"IPtary Public
# G 207484
Commission No. (Seal)
=. •� Commission
oP? My Commission Expires
REVIEWS
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DATE
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RECEIVED
[DATE
COMPLETED
Rev. 5/ b/ LU