HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: — 1 Permit Number: V
RECEIVED
APR e 1 2021
Building Permit Application Permitting Departmen,
Planning and Development Services St. cie Coen*
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: QgCt'7
Address:
Property Tax ID#: �e�n - o ' ' D V Lot No.
l`�K.�cI Site Plan Name: V*AJZ-t OJV Block No.
Project Name: Pnck no
DETAILED DESCRIPTION OF WORK ? h ,
n I I 0)
�A 401 I v, O L-) J , Lvn�, 'Eaj�-
J S u
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORIti/IATION
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:: Sq. Ft. of First Floor:
Cost of Construction:$ U Utilities: —Sewer _Septic Building Height:
Name U+i WQAJ ,
^0Ka Name:
Address: e 4bf c Company:
City: F4 • t r r Lr- State:� Address:
Zip Code: /_ QFax: City: State:
Phone No. - I t9P+ — 0 a Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
I
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 CONSTRUCTION LIEN LAW INF`CaRMATIO`N' '� �° � � � '' �`�`
IN
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _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
improvement you erty. A Notice of Commencement must be recorded in the public records of St.
Lucie Coun a osted on a jobsite before the first inspection. If you intend to obtain financing, consult
with lend n attorne b ore commencin work or recordingour Notice of Commencement.
Signat a of Owner/Lesse ontra or as Agent for Owner Signature of Contractor/License Holder
ST E OF FLORIDA STATE OF FLORIDA
C NTY OF COUNTY OF
to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
SCPP
Physical Presence or Online Notarization Physical Presence or Online Notarization
this_day of_0)o - by ,�� this day of 2020 by
V
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- - I/t Produced
lam.
(Signature of Notary Public- "tate of Florida V (Signature of Notary Public-State of Florida)
'rY
`OSPRY?U9�' A B.HUMPHREY
Commission No. =, ��al 7Commission No. (Seal)
MY COMMISSION }GG 307817
EXPIRES:March 6,2023 uS
fi!__ ET:T7 Bonded Thru No ary Pubic Underwriters
REVIEWS FRO�1 � `70' I57PFity/fS�R PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.5/6/20