HomeMy WebLinkAboutBuilding Permit Application All APPLIC LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: Jyj
01To[LUCQ1 RECEIVED
o MAR 0 3 7021
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Building Permit Application Permitting Dapartmeit
Planning and Development Services St. Lucie County
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
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Property Tax ID#: a.��` ��p . � ,�p1� fl in- Lot No.
Site Plan Name: Block No.
Project Name:
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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: (�V Sq. Ft. of First Floor:
Cost of Construction: $ ._ — Utilities: _Sewer _Septic Building Height:
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ODUNER/LESSEEt"i ,CONTRACTOR -�;
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Name Name:
Address: '(� Company:
City: State: Address:
Zip Code: Fax: City: State:
Phone No. r �1 Zip Code. Fax:
E-Mail: 111 ��\tU��� � LQ{� _ Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
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.
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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 on the jobsite before the first inspection. If you intend to obtain financing, consult
w' h lender or an atto a efore commencing work or recording our Notice of Commencement.
Slgna er/Lessee/Contractor as Age t fo caner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �_,�1�It. COUNTY OF
Swo0 to(or affirmed)and subscribed before me of Sworn to(or affirmed) and subscribed before me of
Y ysical Presence or Online Notarization Physical Presence or Online Notarization
this day of V( 202V by this day of 2020 by
Name o pers n making statement. / Name of person making statement.
Personally Known OR Produced Identification v Personally Known OR Produced Identification
e of Identification
of Identifi ion Type Produced
roduced
(Signature of Notary PutN S. NI ELSEN (Signature of Notary Public-State of Florida)
State of Florida-Notary Publi
Commission No. _• *° Co4,kggion # GG 207484 ommission No. (Seal)
My Commission Expires
June 12, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20