HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 327. -2) Permit Number: &'Iob-o
RECEIVED
MAR 18 2021
Building Permit Application Permitting Department -
Planning and Development Services St. Luc . le County
Building and Code Regulation Division Com'mercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR.��C
PROPOSED 0 A b ' V,,# -,, MJNTLOCATION
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Address: �7 (to Dob b21ij C-7
Property Tax ID #: (12 00. Lo Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK*
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New Electrical Meter Second Electrical Meter
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CONSTRUCTION
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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:
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
45-
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Name v-w 0Qek13
Name:
Company:
Address: SIN, J?,>
City: State:
Zip Code: Fax:
Phone No.
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail: M JS� 14107ILLA FSCJ �DQnMaE,
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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.
SUPPLEMENTAL. -CO STR C 1,0NLIEN LAIN INFORMATION
=:.
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.
Luci C unty and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with�le der or an attorney before commencing work or recording our Notice of Commencement.
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Signature of Contractor/License Holder
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 24 P$ ,
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of% 2020 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
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
2D�__ M.%
—
(SIenatu a of Notary Public- ate of Florida)
(Signature of Notary Public- State of Florida )
Commission No.
LASHMINAINGRAM-RAHMING
=.; .. MY COMION
Commission No. (Seal)
REVIEWS
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PLANS
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SEA TURTLE
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REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Vev--.576/20