HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �OZI Permit Number:
a,��r�—�Q�
RECEIVED
Or. [LUCCEE� , FEB ®3 2021
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oU
Building Permit Application lermitting Department
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
Address:
Property
Site Plan Name:
Project Name:
MrA
New Electrical Meter Second
Block No.�
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: 19 Sq. Ft. of First Floor:
Cost of Construction: $ ��i'!j'_OD Utilities: —Sewer —Septic Building Height:
Name &ckia AU IIIName:
=
Address: l '
City: Stater
Zip Code: 3Lq 92,
''``Fax:
Phone No P— ® _V
Company:
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail: l �, .0, f M
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
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
Name: J-0,vigh 1,. toImGrs
Address:lco:? 60,1 &e_ao R✓e,
City: U/�ItITe- Stater
Zip: 319ccTti Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:_
Address:
City:
Zip:
Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY
Name:
Address:
Citv:
Zip: Phone:
Not Applicable
te:
Not Applicable
r]WIVFR/ CANTRACTf1R AFFInVIT- Anniiratinn is herehv made to ohtain a nermit 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
imprre ements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucid CAuntWnd posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with en e r an attorney before commencine work or recording your Notice of Commencement.
Signat "e o Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA /
�.
STATE OF FLORIDA
COUNTY OF o� C.0(1
COUNTY OF
Swoyn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
✓ h sical Pres nce or Online Notarization
this day of 2021 by
Physical Presence or Online Notarization
this day of 2020 by
Name of person making statement.
Name of person making statement.
/
Personally Known OR Produced Identification 't/
Personally Known OR Produced Identification
Type of Identifica . n
Type of Identification
Produced b �
LK.'d
Produced
(Signature of Not
(Signature of Notary Public- State of Florida )
�tiFpY KAREN S. NIELSEN
Commission No.
,a° State of FI�r��'d��a-�lotary public
°• •= mmissib'fJGG
Commission No. (Seal)
207a84
;�F °P My Commission Expires
'•
June 12
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Rev. 5/6/20